Minimally aortic valve surgery avoiding sternotomy

Area of Science:

• Cardiac Surgery
• Minimally Invasive Procedures
• 3-D Video-Assisted Surgery

Background:

• Minimally invasive valve surgery is an evolving field with potential to advance cardiac procedures.
• A novel approach for aortic valve surgery using a right anterior minithoracotomy was developed.

Purpose of the Study:

• To evaluate the feasibility and outcomes of aortic valve replacement through a right anterior minithoracotomy.
• To assess the safety and efficacy of a 3-D video-assisted approach for this procedure.

Main Methods:

• Aortic valve replacement was performed in seven patients (14% female, mean age 58) using a right thoracotomy, avoiding sternotomy.
• Central aortic and right atrium cannulation was used in four patients; femoral artery return in three.
• Antegrade cardioplegia was administered to all patients.

Main Results:

• Zero operative mortality was observed.
• Patients received mechanical valves (n=4), biological valves (n=2), or valve decalcification (n=1).
• Mean pump time was 110 minutes, cross-clamp time 72 minutes, and hospital stay 7.7 days. All surviving patients showed clinical improvement.

Conclusions:

• The right anterior minithoracotomy provides adequate visualization for safe aortic valve surgery.
• This approach is less traumatic and painful, avoiding rib removal.
• It is a viable option for patients with sternal issues, previous cardiac surgery, or specific anatomical characteristics.