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Minimally Invasive Aortic Valve Replacement (mini-AVR) and Coronary Artery Bypass via limited Anterior Right Thoracotomy
Parvez K. Sultan, Clifton T. Lewis, Richard Stephens, PA-C.
St. Vincent's Health System, Birmingham, AL, USA.
OBJECTIVE: A limited right anterior thoracotomy for aortic valve replacement has been established as a safe alternative to median sternotomy for isolated aortic valve disease. We report our technique for right mini-thoracotomy for AVR and CABG to the RCA.
METHODS: A 5cm, second intercostal space incision with femoral cannulation and retrograde cardioplegia delivered through a R-IJ catheter allows access to the aortic root and right coronary artery to safely complete minimally invasive AVR and CABG
RESULTS: Two patients age 89 male, and 80 female successfully underwent this procedure. Crossclamp times were 93m and 75m respectively and bypass times were 130m and 117m. We implanted porcine supra-annular valves size 25 and 21. There were no post-op complications. The patients were discharged home on day 9 and day 7 after surgery. Both patients were transfused for preexisting anemia and patient 2 received a permanent pacer in the postoperative period for tachy-brady syndrome. At intermediate followup, both remain alive and well.
CONCLUSIONS: AVR/CABG with single vessel bypass to the right coronary artery is possible through a small right anterior thoracotomy, for patients with the high grade proximal right coronary artery disease that is not ammenable to stenting and a hybrid approach, in carefully selected patients.
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