Related Experiment Video
Updated: Dec 30, 2025
08:50
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
12.1K
Minimally Invasive Endoscopic Aortic Valve Replacement: Operative Results
Giovanni Domenico Cresce1, Massimo Sella1, Tommaso Hinna Danesi1
1Division of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy.
Seminars in Thoracic and Cardiovascular Surgery
|January 24, 2020
Summary
Endoscopic aortic valve replacement (E-AVR) is a safe and effective minimally invasive technique with low mortality. Sutureless valves significantly reduce procedure times in E-AVR, offering a promising alternative for aortic valve surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracic Surgery
Background:
- Aortic valve disease, including stenosis and insufficiency, necessitates effective treatment options.
- Minimally invasive cardiac surgery aims to reduce surgical trauma and improve patient recovery.
- Endoscopic Aortic Valve Replacement (E-AVR) represents an advancement in minimally invasive approaches.
Purpose of the Study:
- To detail the endoscopic aortic valve replacement (E-AVR) technique.
- To assess the early clinical outcomes of E-AVR across various prosthetic valve types and patient demographics.
- To establish E-AVR as a viable alternative to traditional and other minimally invasive cardiac procedures.
Main Methods:
- A cohort of 125 patients underwent isolated E-AVR between July 2013 and September 2018 for severe aortic stenosis or insufficiency.
- Surgical access involved a small working port (3-4 cm) in the second right intercostal space without rib-spreading, supplemented by three 5 mm miniports.
- Cardiopulmonary bypass was established via femoro-femoral cannulation, with different prosthetic valve types (stented, Rapid Deployment, Sutureless) implanted.
Main Results:
- All 125 patients successfully completed E-AVR with low 30-day mortality (0.8%) and minimal complications (0.8% re-exploration for bleeding, 2.4% new pacemaker implantation).
- No major neurological events or paravalvular leakage were observed at discharge.
- Sutureless bioprostheses demonstrated significantly shorter mean cross-clamping (69.1 min) and cardiopulmonary bypass (106.2 min) times compared to Rapid Deployment and stented valves.
Conclusions:
- Endoscopic aortic valve replacement (E-AVR) is a safe procedure associated with low mortality and few complications.
- The use of sutureless bioprostheses in E-AVR significantly reduces operative times (cross-clamping and CPB).
- E-AVR, particularly in experienced centers, presents a valuable alternative to other minimally invasive cardiac surgical techniques for aortic valve disease.
