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Single access for minimally invasive aortic valve replacement
C Minale1, H J Reifschneider, E Schmitz
1Department of Cardiothoracic and Vascular Surgery, Witten-Herdecke University in Wuppertal, Klinikum Wuppertal, Germany.
Background:
The method of replacing the aortic valve via a minithoracotomy has been reported in the recent literature. Although this strategy has clear advantages, further refinements of the process make the procedure even less invasive.
Methods:
Aortic valve replacement was performed in 27 patients via a right parasternal minithoracotomy without rib resection. Cardiopulmonary bypass was connected through the same access site. Standard surgical technique and equipment were employed.
Results:
There were no intraoperative complications. All patients survived and could be discharged home within 1 week, except 1. Cardiopulmonary bypass time, aortic cross-clamp time, and total operating time averaged 114 +/- 26, 76 +/- 19, and 190 +/- 40 minutes, respectively. Three patients could be extubated in the operative theater, the others in the intensive care unit at an average of 10 +/- 7 hours postoperatively. Chest drainage lost averaged 430 +/- 380 mL.
Conclusions:
The advantages of this method include further reduction of surgical trauma, early mobilization, and rehabilitation of the patient. Surgical technical improvements include avoidance of groin cannulation, simpler equipment, safe venting of the left ventricle, and preservation of chest wall integrity.