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Minimally invasive "pocket incision" aortic valve surgery
1Department of Cardiothoracic Surgery, National Heart Institute, 145 Jalan Tun Razak, Kuala Lumpur 50400, Malaysia.
Abstract:
A minimally invasive approach to aortic valve surgery through a transverse incision ("pocket incision") at the right second intercostal space was examined. Sixteen patients with a mean age of 30 years underwent this approach. The third costal cartilage was either excised (n = 5) or dislocated (n = 11). The right internal mammary artery was preserved. Cardiopulmonary bypass (CPB) was established with aortic-right atrial cannulation in all except the first case. Aortic valve replacements (AVR) were performed in 15 patients and one had aortic valve repair with concomitant ventricular septal defect closure. There was no mortality and no major complications. The aortic cross-clamp, CPB and operative times were 72 +/- 19 mins, 105 +/- 26 mins and 3 hrs 00 min +/- 29 mins respectively. The mean time to extubation was 5.7 +/- 4.0 hrs, ICU stay of 27 +/- 9 hrs and postoperative hospital stay of 5.1 +/- 1.2 days. Minimally invasive "pocket incision" aortic valve surgery is technically feasible and safe. It has the advantages of central cannulation for CPB, preservation of the internal mammary artery and avoiding sternotomy. This approach is cosmetically acceptable and allows rapid patient recovery.
Insights
Minimally invasive aortic valve surgery using a "pocket incision" is safe and feasible. This approach offers cosmetic benefits and faster recovery without sternotomy.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Thoracic Surgery
Background:
- Minimally invasive cardiac surgery is gaining traction.
- Traditional sternotomy for aortic valve surgery carries risks.
- Alternative surgical approaches are needed.
Purpose of the Study:
- To evaluate the feasibility and safety of a novel minimally invasive approach for aortic valve surgery.
- To assess patient outcomes and recovery associated with the
- Main_Methods.md
- Main_The_approach_involved_a_transverse_incision_at_the_right_second_intercostal_space.
- The_third_costal_cartilage_was_either_excised_or_dislocated.
- Cardiopulmonary_bypass_(CPB)_was_established_using_aortic-right_atrial_cannulation_in_most_cases.
- Main_Results.md
- No_mortality_or_major_complications_were_observed.
- The_mean_aortic_cross-clamp_time_was_72_minutes.
- Mean_intensive_care_unit_(ICU)_stay_was_27_hours.
- Conclusions.md
- Minimally_invasive_aortic_valve_surgery_via_pocket_incision_is_technically_feasible.
- The_procedure_is_safe_and_associated_with_rapid_patient_recovery.
- Advantages_include_central_cannulation_for_CPB,_preservation_of_the_internal_mammary_artery,_and_avoidance_of_sternotomy.
Main Methods:
- Minimally invasive approach using a transverse
- Minimally_invasive_aortic_valve_surgery_using_a_transverse_incision_was_evaluated_in_16_patients.
- The_study_assessed_the_technical_feasibility,_safety,_and_outcomes_of_this_novel_approach.
- Key_outcomes_included_no_mortality_and_no_major_complications.
Main Results:
- No mortality or major complications were observed in the 16 patients.
- Mean aortic cross-clamp time was 72 minutes, CPB time was 105 minutes.
- Average extubation time was 5.7 hours, ICU stay was 27 hours, and hospital stay was 5.1 days.
Conclusions:
- Minimally invasive aortic valve surgery via pocket incision is technically feasible and safe.
- This approach offers advantages such as central cannulation for cardiopulmonary bypass (CPB), preservation of the internal mammary artery, and avoidance of sternotomy.
- The technique is cosmetically acceptable and leads to rapid patient recovery.