Endoscopic Aortic Valve Replacement: Initial Outcomes of Isolated and Concomitant Surgery

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Cardiac Valve Repair and Replacement

Background:

• The feasibility of totally endoscopic surgical aortic valve replacement (AVR) in patients requiring multiple valve procedures was previously unknown.
• This study aimed to describe the approach and evaluate perioperative outcomes of totally endoscopic AVR, both isolated and in conjunction with other valve surgeries.

Purpose of the Study:

• To assess the applicability and safety of totally endoscopic aortic valve replacement (AVR) in patients undergoing isolated or concomitant valve operations.
• To evaluate perioperative outcomes, including mortality and major adverse events, associated with this minimally invasive technique.

Main Methods:

• A total of 216 patients underwent totally endoscopic AVR between May 2017 and October 2022 using a 3-port technique.
• Procedures involved a main port, a 3D endoscopic port, and a left-hand port with femoral cannulations; sutures were hand-tied.
• Perioperative outcomes were compared between patients with and without concomitant procedures.

Main Results:

• Concomitant surgery was performed in 15.2% of patients, most commonly involving mitral valve procedures (63.6%).
• Various valve types were implanted, with stented bioprostheses being the most frequent (76.3%).
• The study reported low 30-day mortality (0.5%), low conversion to sternotomy rate (0.9%), and a low incidence of major neurologic events (1.4%), with similar adverse event rates in both isolated and concomitant AVR groups.

Conclusions:

• Totally endoscopic AVR is a safe and effective approach for patients requiring isolated or concomitant valve procedures.
• This minimally invasive technique can be successfully applied to address multivalve disease, offering comparable safety to isolated AVR.