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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

Left axillary approach for pulmonary valve replacement.

Juan-Miguel Gil-Jaurena¹, Carlos Pardo¹, Ana Pita¹

¹Department of Congenital Cardiac Surgery, Gregorio Maranon University Hospital, Madrid, Spain.

Multimedia Manual of Cardiothoracic Surgery : MMCTS

|December 18, 2023

Summary

This study details a minimally invasive pulmonary valve replacement in a 14-year-old girl with an aneurysmal pulmonary artery. The successful procedure utilized a left axillary approach, demonstrating a viable alternative for complex cardiac surgeries.

Keywords:

Congenital Congenital cardiac surgery Minimally invasive Minimally invasive cardiac surgery Minithoracotomy Pediatric cardiac surgery Pulmonary artery surgery

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Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Pediatric Cardiac Surgery

Background:

Pulmonary valve replacement is a critical procedure for managing various cardiac conditions.
Enlarged cardiac silhouette and aneurysmal pulmonary artery present unique surgical challenges.
Minimally invasive techniques are increasingly explored to improve patient outcomes.

Observation:

A 14-year-old female patient presented with an enlarged cardiac silhouette and an aneurysmal pulmonary artery.
Computed tomography scan confirmed the anatomical abnormalities.
A less-invasive surgical approach via the left axilla was selected for pulmonary valve replacement.

Findings:

The surgical team employed a less-invasive technique through a left axillary incision.
Peripheral cannulation for cardiopulmonary bypass was achieved via right groin dissection.
A 25-mm biological valve was implanted in the beating heart, with successful arteriotomy closure.
Cardiopulmonary bypass duration was 64 minutes, followed by sequential cannula removal.

Implications:

This case highlights the feasibility of a minimally invasive approach for pulmonary valve replacement in pediatric patients with complex anatomy.
The successful outcome suggests potential benefits, including reduced trauma and improved recovery.
Further research into minimally invasive cardiac surgery techniques is warranted for complex congenital heart disease.