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Related Experiment Video

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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Sutureless Aortic Valve Replacement Through Lateral Mini-Thoracotomy　- Feasibility and Effectiveness.

Yoshitsugu Nakamura1, Takuya Narita1, Miho Kuroda1

  • 1Department of Cardiovascular Surgery, Chibanishi General Hospital.

Circulation Journal : Official Journal of the Japanese Circulation Society
|July 27, 2022
PubMed
Summary

Lateral thoracotomy (LT) offers advantages for minimally invasive sutureless aortic valve replacement (MISUAVR) compared to anterior thoracotomy (AT). LT reduces the need for rib and artery cutting, improving surgical visualization and decreasing bleeding.

Keywords:
Aortic stenosisAortic valve replacementMinimally invasivePercevalSutureless valve

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Medical Devices

Background:

  • Minimally invasive sutureless aortic valve replacement (MISUAVR) is frequently performed via right anterior thoracotomy (AT).
  • Lateral thoracotomy (LT) presents a potential alternative, avoiding rib and right internal thoracic artery (RITA) cutting.

Purpose of the Study:

  • To compare the outcomes of MISUAVR performed using LT versus AT.
  • To evaluate surgical visualization, intraoperative bleeding, and procedural times between the two approaches.

Main Methods:

  • Retrospective review of 38 MISUAVRs (21 LT, 17 AT) performed between May 2019 and August 2021.
  • Comparison of patient demographics, cardiopulmonary bypass and cross-clamp times, need for rib/RITA cutting, surgical visualization scores, and intraoperative bleeding.

Main Results:

  • No significant differences in cardiopulmonary bypass or cross-clamp times between LT and AT groups.
  • Significantly less rib and/or RITA cutting required in the LT group (0%) compared to the AT group (94.6%).
  • Improved surgical visualization (P<0.01) and reduced intraoperative bleeding (P<0.01) in the LT group.

Conclusions:

  • Lateral thoracotomy (LT) demonstrates significant advantages for MISUAVR over anterior thoracotomy (AT).
  • LT facilitates better surgical visualization and less intraoperative bleeding without increasing procedure time.
  • MISUAVR via LT is a superior approach, minimizing invasiveness by avoiding rib and RITA cutting.