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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
Aortic valve replacement through right minithoracotomy in 306 consecutive patients
Donald D Glower1, Teng Lee, Bhargavi Desai
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27705, USA. glowe001@mc.duke.edu
Innovations (Philadelphia, Pa.)
|March 23, 2012
Summary
Right minithoracotomy is a safe alternative for aortic valve replacement, especially for elderly patients. This approach offers early recovery and potential for hybrid procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Aortic valve replacement (AVR) traditionally involves median sternotomy.
- Minimally invasive approaches are gaining traction to reduce surgical trauma.
Purpose of the Study:
- To evaluate the role and early outcomes of AVR using a right minithoracotomy approach.
- To assess the safety and efficacy of this technique in a consecutive patient cohort.
Main Methods:
- Retrospective analysis of 306 patients undergoing AVR via an 8-cm right minithoracotomy.
- Inclusion of initial surgical experiences with standard instruments and digital knot tying.
- Use of anterograde/retrograde cardioplegia with percutaneous femoral and direct aortic cannulation.
Main Results:
- Mean patient age was 65 years; common etiologies included calcific and bicuspid aortic valve disease.
- Low 30-day mortality (1%) and minimal major complications (stroke 1.6%, new pacemaker 4%).
- Median postoperative stay was 5 days, with rapid return to preoperative activities within 2 weeks.
Conclusions:
- Right minithoracotomy is a safe, albeit limited, alternative to sternotomy for isolated AVR.
- This approach is beneficial for higher-risk, elderly patients and facilitates hybrid procedures.
- Early results demonstrate favorable outcomes and patient recovery.
