Thoracoscopic Aortic Valve Surgery Maximizing Results Minimizing Damage
Rodrigo Ribeiro de Souza, Tercio Campos Leao Neto.
Hospital São Francisco de Assis, Goiania, Brazil.
BACKGROUND - To describe the experience and results of 14 cases of aortic valve replacement performed by minithoracotomy and thoracoscopy without direct vision, analyzing the technique used and the results found.
METHODS - A survey of medical records of patients submitted to minimally invasive aortic valve repair, performed under thoracoscopic vision without direct vision, in the period from january 2017 to november 2018. It is an observational, analytical, retrospective.RESULTS - The sample consists of 14 patients, with a mean age of 55 years, male prevalence, mean LVEF of 58%, mean Euroscore II of 3,2%, moderate risk, medium sized incisions of 4,6 cm, 3 to 5 cm length performed in the 2nd left intercostal space initiated laterally to the hemiclavicular line, which differently from the technique under direct vision prevents the procedure from performing without thoracoscopic visualization. The 5mm and 30 degree optics were inserted in the same intercostal space in the anterior axillary line. All patients had an established ECC with median total CPB time of 87,9 min, clamping performed using the Chitwood clamp inserted an intercostal space above, in the hemiclavicular line with mean aortic crossclamp time of 48,5 min. In all cases we implanted a bioprostheses chosen of numerous brands. Patients received thoracic drainage at the end of the operation and the mean volume of drainage in the first 12 hours was 218 ml. The mean mechanical ventilation time was 5 hours, 4 of 14 patients were extubated in the first postoperative hour. The average length of stay in the ICU was 18 hours and hospital stay of 3,6 days. All patients resumed their normal activities without limitations between 7 to 10 days.CONCLUSIONS - There is a real space between TAVR and SAVR, being suitable for the MICS AVR, thoracoscopically executed, using a rapid deployment valve or a standard valve. This technique is an example for the hospitals and surgeons who still dos not have RDV or TAVR as a everyday tool and shows exceptional results compared head to head to TAVR.
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