Ascending Aorta And Aortic Valve Replacement With Sutureless Valve Through A Ministernotomy Approach
Antonio Lio, Antonio Miceli, Matteo Ferrarini, Mattia Glauber.
Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy.
Objective: A significant proportion of patients undergoing aortic valve replacement (AVR) have a dilated ascending aorta that need surgical replacement. Aortic valve surgery combined with surgery of the ascending aorta is not yet widely performed through a mini-invasive surgical incision. Moreover, presence of concomitant ascending aorta aneuryms is viewed as a contraindication for sutureless valve implantation for the potential risk of prosthesis dislodgment. We describe our first experience of sutureless prosthesis implantation and concomitant ascending aorta replacement thorugh an upper ministernotomy.
Methods: A retrospective study was undertaken on 7 consecutive patients undergoing AVR with a sutureless valve and ascending aorta replacement between November 2014 and October 2016.
The upper ministernotomy consisted of a 6-7 cm midline skin incision and a J-shaped sternal midline incision made into the 2nd or 3rd intercostal space. Cardiopulmonary bypass (CPB) was estabilished using direct cannulation of the aortic arch and with a double-stage venous return cannula placed percutaneously into the right femoral vein. Diameter of vascular graft for ascending aorta replacement was choosen according to the size of the selected prosthesis, to recreate a ratio between diameters of the new sinotubular junction and the aortic annulus that should be less than 1.3. Technically, it is mandatory to perform the proximal anastomosis of the tubular dacron graft before sutureless prosthesis implantation.
Results: Mean age was 74.6 ± 8.7 years. 3 patients underwent a previous cardiac operation. Postoperatively no patient died in hospital. No paravalvular leakage or prosthesis dislodgment was reported. Mean CPB and cross-clamp times 142 ± 52 min and 85 ± 18 min, respectively.
Conclusions: In patients undergoing AVR and ascending aorta replacement, sutureless valve implantation is a safe and reproducible procedure associated with good postoperative results.
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