Ultra Fast Track Mini Aortic Valve Replacement: A Paradigm Shift To A Real Minimally Invasive Approach
Marco Di Eusanio, MD, PhD1, Walter Vessella2, Filippo Capestro1, Alessandro D'alfonso1, Saha M. L. Matteucci1, Carlo Zingaro1, Roberto Carozza3, Christopher Munch2, Paolo Berretta, MD1.
1Cardiac Surgery Unit - Ospedali Riuniti, Ancona, Italy, 2Cardiac Anaesthesia and Intensive Care Unit - Ospedali Riuniti, Ancona, Italy, 3Perfusion Unit - Ospedali Riuniti, Ancona, Italy.
OBJECTIVE: We present our multidisciplinary minimally invasive program to treat patients who require aortic valve replacement (AVR).
METHODS: Our approach involved: 1) reduced chest incision, aiming to both decreasing “invasiveness” of the surgical procedure and improving clinical and cosmetic outcomes; 2) rapid deployment aortic valve replacement (RD-AVR), to reduce operative times, to facilitate minimally invasive approach and to improve haemodynamic outcomes; 3) minimal invasive extracorporeal circulation system, to improve circulatory support, end-organ protection, and to promote fast track anaesthesia; 4) ultra fast track anaesthesia, to assure better comfort and outcomes for patient and to promote early recovery.
RESULTS: RD-AVR was performed through a J-ministernotomy at the 4th intercostal space. Cross-clamp time and cardio-pulmonary bypass time were 31 and 42 minutes respectively. The patient was extubated in the operating room. Total blood loss was 90 cc, and no transfusion was required. Mobilization therapy and oral feeding were started 14 hours after the intervention and the patient was uneventfully discharged on postoperative day 5.
CONCLUSIONS: We advocate that this multidisciplinary minimally invasive approach may be associated with superior patients’ outcomes, faster recovery, and increased comfort compared to conventional AVR.
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