Is placing an aortic stent (aortic stent) considered an open heart procedure?

Aortic Stent Placement Is Not an Open Heart Procedure

No, placing an aortic stent is not an open heart procedure. Endovascular stent grafting is specifically designed as a minimally invasive alternative to open surgical repair, avoiding the need for thoracotomy, sternotomy, and cardiopulmonary bypass 1.

Endovascular vs. Open Surgical Approaches

Endovascular Stent Grafting

• Performed through small incisions in the groin or abdomen
• Uses catheter-based techniques to deliver and deploy stents through blood vessels
• Does not require opening the chest cavity
• Does not require cardiopulmonary bypass in most cases
• Avoids the need for aortic cross-clamping 1

Key Advantages of Endovascular Approach

• Absence of thoracotomy incision
• No need for partial or total extracorporeal circulatory support
• Lower hospital morbidity rates
• Shorter length of hospital stay 1
• Particularly valuable for patients with significant comorbidities (older age, cardiac, pulmonary, and renal dysfunction) 1

Procedural Details

Endovascular stent grafting involves:

1. Access through femoral artery (in 52% of cases) or abdominal aortic access (in 48% of cases) 2
2. Navigation of the stent graft through the vascular system under fluoroscopic guidance
3. Precise positioning at the target site
4. Deployment of the stent graft to exclude the aneurysm 2

The procedure is performed in an angio-radiologic operating theater that is specially prepared for emergency conversion to open surgery if needed 3.

Clinical Evidence Supporting Non-Open Heart Classification

Comparative studies demonstrate the less invasive nature of stent grafting:

• 30-day mortality rates significantly lower for stent grafting (5%) compared to open surgery (27%) 4
• ICU stays significantly shorter for stent grafting (4.3 days vs. 10.0 days) 4
• Hospital stays significantly shorter for stent grafting (11.9 days vs. 21.5 days) 4

Important Distinctions

It's important to distinguish between different aortic procedures:

1. Endovascular stent grafting (not open heart):

   • Minimally invasive
   • No thoracotomy or sternotomy
   • No cardiopulmonary bypass required

2. Open surgical repair (open heart procedure):

   • Requires thoracotomy or sternotomy
   • Often requires cardiopulmonary bypass
   • Direct surgical replacement of the diseased aortic segment 1

3. Hybrid procedures (partial open heart):

   • Combine elements of both approaches
   • Example: "Elephant trunk" procedure where open surgical repair of the arch is followed by endovascular stent placement 1

Anesthesia Considerations

The non-open heart nature of aortic stent placement is further evidenced by anesthesia practices:

• Epidural anesthesia is often preferred for abdominal aortic stent placement
• General anesthesia is used for thoracic stent placement or when epidural is contraindicated 3
• Does not require the deep hypothermic circulatory arrest typically needed for open heart procedures 1

Conclusion

Aortic stent placement is definitively classified as an endovascular procedure, not an open heart procedure. This distinction is important for patient education, procedural planning, and risk assessment.