目的:总结我科各类经胸骨上段小切口主动脉手术的临床经验，探讨胸骨上段小切口入路主动脉手术的安全性及可靠性。方法:回顾性分析2016年6月至2019年10月于解放军总医院心血管外科接受胸骨上段小切口各类主动脉手术患者的一般资料、围术期数据及临床结果，共63例纳入本次研究，其中男51例(81.0%)，女12例；年龄(49.7±12.7)岁。主动脉夹层手术33例，Bentall手术9例，Wheat手术7例，Ross手术2例，David手术2例，单纯升主动脉置换2例，二次开胸Bentall手术3例，二次开胸Wheat手术2例，二次开胸主动脉根部内漏修补术1例，二次开胸升主动脉、无名动脉、左颈总动脉置换＋主动脉内赘生物清除术1例，二次开胸Bentall＋肺动脉瓣、肺动脉置换术1例。其中主动脉夹层手术包括升主动脉、全弓替换＋降主动脉支架置入11例，主动脉瓣置换(AVR)＋升主动脉置换2例，升主动脉、半弓替换5例，David＋升主动脉及全弓替换＋降主动脉支架置入4例，二次开胸David＋升主动脉、全弓替换＋降主动脉支架置入1例，David＋升主动脉置换1例，主动脉瓣成形(AVP)/AVR/Bentall＋升主动脉、全弓替换＋降主动脉支架置入术6例，二次开胸升主动脉、全弓替换＋降主动脉支架置入2例，主动脉根部人工血管包裹＋升主动脉、全弓替换＋降主动脉支架置入术1例。结果:全部63例手术均顺利完成，无中转延长切口，无术中死亡发生。1例术后出现急性肾衰竭行透析治疗，后合并感染性休克、颅内出血死亡；2例术后二次开胸探查止血术；9例出现心包积液需心包穿刺治疗；2例术后出现下肢肌力减弱，1例经脑脊液引流后下肢肌力基本恢复，1例合并感染、急性肾衰竭、低氧血症，经积极抗感染、持续床旁血滤、丙种球蛋白冲击及康复锻炼后下肢肌力恢复，其余患者未出现院内并发症。结论:胸骨上段小切口入路对于主动脉根部、升主动脉及弓降部显露良好，能够顺利实施各类主动脉手术，临床效果较为满意。“,”Objective:To summarize the feasibility and clinical experience of various types of aortic surgery through upper hemisternotomy.Methods:From June 2016 to October 2019, 63 patients underwent various types of aortic operations through upper hemisternotomy in our department. Among them, there were 51 males and 12 females with an average age of(49.7±12.7) years. All kinds of major vascular operations include: 33 cases of aortic dissection procedure; 9 cases of Bentall procedure; 7 cases of wheat procedure; 2 cases of Ross procedure; 2 cases of David procedure; 2 cases of simple ascending aorta replacement procedure; 3 cases of redo thoracic Bentall procedure; 2 cases of redo thoracic wheat operation; 1 case of redo thoracic aortic root leakage repair procedure; 2 cases of redo thoracic ascending aorta procedure, innominate artery, left common carotid artery replacement and removal of intravalvular vegetation procedure; 1 case of Bentall plus pulmonary valve and pulmonary artery replacement procedure. Among them, aortic dissection included 11 cases of ascending and total arch replacement plus descending aortic stent implantation procedure; 2 cases of AVR plus ascending and total arch replacement procedure; 5 cases of ascending and semi-arch replacement procedure; 4 cases of David plus ascending and total arch replacement plus descending aortic stent implantation procedure; 1 case of redo thoracotomy David plus ascending and total arch replacement with descending aortic stent implantation procedure; 1 case of David plus ascending and total arch replacement procedure; 6 case of AVP/AVR/Bentall plus ascending and total arch replacement and descending aortic stent implantation procedure; 2 cases of redo total arch replacement and descending aortic stent implantation procedure and aortic root vascular graft wrapping plus ascending aorta and 1 case of total arch replacement with descending aortic stent implantation procedure.Results:All 63 cases of operation were successfully completed without transforming to middle sternotomy; 1 case with acute renal failure was treated by dialysis, and then complicated with septic shock and intracranial hemorrhage, and died of ineffective rescue; 2 cases were treated by thoracotomy exploration and hemostasis; 9 cases with pericardial effusion needed pericardiocentesis; 2 cases with lower extremity muscle weakness after operation: one treated by drainage of spinal fluid and the muscle strength of the lower extremities was restored, another one complicated with infection, acute renal failure and hypoxemia was treated by anti-infection, continuous CRRT, gamma globulin infusion and rehabilitation exercise, the muscle strength of the lower extremities was eventually restored. Except for one death in hospital, all the other patients were cured and discharged.Conclusion:Well exposure of aortic root, ascending aorta and descending part of arch can be obtained through upper hemisternotomy and various types of aortic proceduer can be done with satisfactory results through this approach.