International Society For Minimally Invasive Cardiothoracic Surgery

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Standardized Aortic Valve Repair Using A Minimally-Invasive Approach A Single Center Experience
Johannes Petersen, Theresa Holst, Niklas Schofer, Christoph Sinning, Hermann Reichenspurner, Evaldas Girdauskas.
University Heart Center Hamburg, Hamburg, Germany.

Background: Aortic valve repair (AVR) is evolving towards a standard of care in patients with aortic valve regurgitation (AR). We aimed to analyze our experience with standardized minimally-invasive approach for aortic valve repair during the last 2 years.
Methods: A total of 100 consecutive patients with aortic valve regurgitation and/or aortic root dilatation underwent AVR at our institution since January 2016. A total of 55 (55%) patients were treated via minimally invasive approach (MICS), independently of aortic valve morphology. Minimally invasive surgical access included partial upper sternotomy and percutaneous femoral venous drainage. Baseline, intraoperative and postoperative data were prospectively collected and analyzed. Echocardiographic follow-up was available for the whole study cohort.
Results:
A total of 100 young, predominantly male patients (mean age was 46.314.9 years, 79% male) with a low perioperative risk (STS-Score 1.040.79%) and unicuspid 7 (7%), bicuspid 35 (35%), or tricuspid AV disease were included: An isolated aortic valve repair was performed in 39 patients; additional aortic root reimplantation (n = 34) / remodeling (n = 9) or replacement of ascending aorta (n = 18) was performed. Duration of the procedure (MICS: 25259 vs. complete sternotomy: 30387 minutes, p = 0.059) and aortic cross clamp time (MICS: 9344 vs. complete sternotomy: 10244 minutes, p=0.398) did not differ significantly between both groups, while cardiopulmonary bypass time was significant shorter in the MICS group (MICS: 14151 vs. complete sternotomy: 16763 minutes, p=0.011). In the MICS-group, AVR was successful in all cases without leaving AR ≥ 1 and resulted in max/mean transvalvular gradient of 18.910.6 / 10.36.1 mmHg. In the MICS group, there was no in-hospital mortality and no patient died during follow-up. In the MICS group, freedom of reoperation at 1 year was 97 % and freedom of AR ≥ grade 2 was 96 %.
Conclusions
: Aortic valve repair with or without concomitant aortic root surgery is feasible and safe via partial upper sternotomy access, independently of aortic valve morhology. This approach combines reduced surgical trauma with a superior cosmetic result.


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