Abstract: Objective To summarize the clinical experience of type A aortic dissection through ministernotomy and explore the safety and reliability of type A aortic dissection through ministernotomy.Methods Retrospective analysis of 471 patients with type A aortic dissection from June 2019 to Mar 2022(35 patients underwent ministernotomy,436patients underwent full sternotomy).Two cohorts including 35 patients in MS group and 70 patients in FS group were matched by tendency score matching,the baseline data and perioperative indicators were analyzed.35 ministernotomy operations include:24 cases of ascending and total arch replacement procedure; 8 cases of Bentall plus total arch replacement procedure; 3 cases of David procedure.Results All 35 cases of operation were successfully completed without transforming to full sternotomy; 1 case was treated by thoracotomy operation and hemostasis;2 cases with acute renal failure were treated by dialysis,All the patients had no complications of sternal opening after operation,and the incidence of pulmonary infection in the MS group was significantly lower than that in FS group.All the patients with ministernotomy were operated successfully and the patients recovered and discharged smoothly. Conclusion Aortic root ,ascending aorta and descending part of arch can be well exposed through ministernotomy,and did not significantly increase the time of operation,the risk of postoperative bleeding and the incidence of perioperative adverse events.

Key words: type A aortic dissection, minimal access approaches, ministernotomy