Evidence map›Paper›PMID 42870968›Full record

ArticleAnnals of cardiothoracic surgery2026

Transaxillary access for ascending aortic and root surgery: a single-center comparison with full and partial sternotomy.

Daniel-Sebastian Dohle, Philipp Pfeiffer, Christian Keller, Edoardo Zancanaro, Ahmed Ghazy, Franz Masseli, Chris Probst, Hendrik Treede

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Article in Annals of cardiothoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Daniel-Sebastian DohleDepartment of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.
Philipp PfeifferDepartment of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.
Christian KellerDepartment of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.
Edoardo ZancanaroDepartment of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.
Ahmed GhazyDepartment of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.
Franz MasseliDepartment of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.
Chris ProbstDepartment of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.
Hendrik TreedeDepartment of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Minimally invasive approaches for ascending aortic and root surgery remain controversial regarding operative complexity and safety. The transaxillary (TAX) approach avoids sternotomy entirely but has not been compared with both full sternotomy (FS) and partial upper sternotomy [minimally invasive cardiac surgery (MIC)]. This study evaluates perioperative outcomes across these three access strategies. Methods: Between January 2022 and December 2025, 194 consecutive patients undergoing elective isolated ascending aortic or root surgery were retrospectively analyzed. Surgical access was FS (n=52), MIC (n=106), or TAX (n=36). TAX suitability was assessed by team consensus on electrocardiogram (ECG)-gated computed tomography (CT). Primary endpoints were in-hospital mortality, major complications [Society of Thoracic Surgeons (STS) composite], and hospital length of stay. TAX was compared with MIC after 1:2 propensity score matching. FS served as descriptive reference. Results: FS patients had higher EuroSCORE II (median 2.7 Conclusions: TAX ascending aortic and root surgery was feasible in carefully selected patients, with no in-hospital mortality, no stroke, and no wound complications. In a propensity-matched comparison with partial upper sternotomy, early outcomes did not differ significantly despite longer bypass time. TAX extends the sternal-sparing concept to the aortic root and ascending aorta and warrants prospective evaluation.

Indexed as

aortic root replacementAscending aortic surgeryminimally invasive cardiac surgery (MIC)right anterior mini-thoracotomy (RAMT)transaxillary (TAX)

Identifiers

PMID42870968
PMCPMC13657871

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