Step-by-Step Minimally Invasive Aortic Valve Replacement: the RAT Approach

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Transcatheter Procedures

Background:

• Transcatheter aortic valve implantation is advancing, necessitating development of less invasive surgical alternatives.
• Elderly and frail patients benefit significantly from reduced surgical trauma and quicker recovery.
• Upper hemisternotomy is a common approach for minimally invasive aortic valve replacement (MIAVR).

Purpose of the Study:

• To describe the technical aspects and preoperative assessment of MIAVR performed via right anterior thoracotomy.
• To highlight the advantages of the right anterior thoracotomy approach over traditional methods.
• To address the challenge of extended operative times in minimally invasive cardiac surgery.

Main Methods:

• Description of MIAVR technique utilizing a right anterior thoracotomy incision.
• Focus on preoperative patient assessment for suitability.
• Recommendation for the use of rapid-deployment valve prostheses.

Main Results:

• Right anterior thoracotomy is associated with less surgical trauma.
• This approach facilitates rapid patient mobilization post-surgery.
• Lower rates of blood transfusion and postoperative wound infections are observed.

Conclusions:

• MIAVR via right anterior thoracotomy presents a less traumatic surgical option with significant patient benefits.
• Rapid-deployment valves are crucial for optimizing operative efficiency in this technique.
• This approach enhances recovery, particularly for vulnerable patient populations.