Minimally aortic valve surgery avoiding sternotomy

Minimally invasive valve surgery, although still in its pioneer era, can open new horizons in cardiac surgery. Following that trend we started aortic valve surgery through a right anterior minithoracotomy using a novel approach under 3-D video-assistance in most of the cases.

Aortic valve replacement avoiding sternotomy through a right thoracotomy was performed in seven patients (14% were female, average age: 58 years) There were five aortic stenoses and two aortic insufficiencies. In four patients we employed central aortic and right atrium cannulation and in three, femoral artery returns. Antegrade cardioplegia was used in all patients.

The operative mortality was 0%, four patients received a mechanical aortic valve, two patients received a biological valve, and in one patient a decalcification of the valve was performed. The mean pump time was 110 min (70-146), the mean cross-clamp time was 72 min (52-95), the mean hospital stay was 7.7 days (4-11 days). One patient died 7 months after the operation of pulmonary insufficiency, the rest of the patients are alive and improved the clinical situation.

This access produces an operative view adequate to safely perform aortic valve surgery. Therefore, removal of ribs or cartilage fragments is not necessary, which results in a less traumatic and less painful approach. Within this is a potential good approach for patients with sternal problems (radiation), redo in certain situations (example previous coronary surgery with LIMA open to LAD). Young patients are potential candidates for future coronary surgery as well as patients with long thoracic cavity and deep aortic plane.