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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Minimal access aortic valve replacement using a minimal extracorporeal circulatory system.
Alaadin Yilmaz1, Atiq Rehman, Uday Sonker
1Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands. a.yilmaz@antonius.net.nl
The Annals of Thoracic Surgery
|February 24, 2009
Summary
Minimal access aortic valve replacement (mAVR) using minimal extracorporeal circulation (MECC) is a feasible and safe technique. This approach offers excellent clinical and cosmetic outcomes for patients undergoing aortic valve surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Extracorporeal Circulation
Background:
- Minimal access aortic valve replacement (mAVR) offers advantages over standard median sternotomy.
- Minimal extracorporeal circulation (MECC) reduces the deleterious effects of conventional cardiopulmonary bypass.
- This study introduces a novel technique combining mAVR with MECC.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a new technique for aortic valve replacement (AVR) using minimal access and MECC.
- To assess the clinical and cosmetic results of this combined approach in a prospective patient cohort.
Main Methods:
- Prospective data collection from 50 patients undergoing mAVR with MECC.
- J-shaped partial upper sternotomy, femoral cannulation via Seldinger technique, pulmonary artery venting.
- Use of warm blood cardioplegia and carbon dioxide field flooding.
Main Results:
- Successful completion of mAVR with MECC in all 50 patients, with no conversions to median sternotomy.
- Mean operative time: 147 min, cross-clamp time: 64 min, perfusion time: 84 min.
- Low complication rate, including one permanent pacemaker, pneumothorax, wound infection, transient neurologic deficit, and one reexploration for bleeding. No renal failure or major strokes. 100% one-month survival.
Conclusions:
- Minimal access aortic valve replacement combined with minimal extracorporeal circulation is a feasible surgical option.
- This technique yields excellent clinical and cosmetic results.
- The approach demonstrates a favorable safety profile with high short-term survival.
