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Minimally Invasive Aortic Valve Replacement: No Groin, A New Perfusion Technique: The “R-R India Method”
ravi K. singh, rajneesh malhotra.
MAX HEART AND VASCULAR INSTITUTE, NEW DELHI, India.

OBJECTIVE: Objectives: The main objective of the technique explained in our study is to develop a technique for doing minimally invasive aortic valve replacement which should avoid all complications of the groin incision involved in femoral cannulation and cannula traffic in central cannulation
METHODS: Method: For Minimally invasive aortic valve replacement (MIAVR), the most popular cannulation technique among the surgeons worldwide is still total femoral cannulation and few surgeons adopt direct ascending aorta cannulation and femoral vein cannulation for venous drainage. Both techniques are associated with groin incision’s complications. Some adopt totally central arterial and venous cannulation technique but reluctant for the same due to crowding of cannulae in surgical field of interest. We have developed our direct technique of perfusion to avoid all complications related to retrograde perfusion, groin exposures and cannula traffic. In our technique we can avoid extra incision in the groin for femoral cannulation, the three stage venous cannula comes out from the mid axillary line through the 5 th intercostal space (the site is used for pleural chest tube insertion after the completion of procedure). Venous cannula completely avoids the surgical field so that there is no crowding by the venous cannula.
RESULTS: Results: We have just employed this technique in our practice and now doing our all the MIAVR with this technique successfully. Till date we have done 5 cases with this technique with 100 % success rate, no mortality, no morbidity, 4 females and 1 male. Mean age 51.8 years (27 to 63), mean weight 66.6kg (37 to 95), mean CPB time 216.8 min (169 to 241) and mean aortic cross clamp time 143.2 min (123 to 168).
CONCLUSIONS: Conclusions: Our technique can be used for minimally invasive aortic valve replacement with good success results without involving any complications of groin incision and retrograde perfusion.


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