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OBJECTIVE: Minimally-invasive aortic valve replacement through right minithoracotomy has been shown to be feasible and effective although cardiopulmonary bypass and cross-clamp times are significantly longer. Hereby we report our initial experience with the sutureless aortic valve implanted through a right minithoracotomy.
METHODS: Since 2010 14 patients have been operated through a right minithoracotomy using the sutureless aortic valve (Medtronic ATS Enable I, USA) for severe aortic stenosis. Mean age was 72.7±6.6 years (9 male, 5 female), BMI 27.1±2.5 kg/m2, EuroScore 6.8±4.7 %. Left ventricular ejection fraction was 61±12.8%. Overall follow-up was 9.7±5.9 months.
RESULTS: All patients survived surgery and there was no hospital mortality and no death during follow-up. Cardiopulmonary bypass time was 98.9±20.8min and cross-clamp time was 57.1±11.9min. 2 sutureless valves dislodged during surgery and were replaced with standard bioprosthesis. Postoperatively there was one revision for bleeding, 2 pacemaker implantations, one stroke and no infections. Mean gradient at discharge was 9.1±3.6mmHg and there was one patient with trivial paravalvular leakage. Mean hospital stay was 10.2±5.3 days.
CONCLUSIONS: Sutureless valve technology is safe, feasible and enables minimally-invasive aortic valve implantation without cumbersome suturing of the valve prosthesis through a small right minithoracotomy. We believe that with the soon available second generation of sutureless valves the right minithoracotomy approach will be even easier and gain further acceptance as a standard approach in minimally-invasive aortic valve replacement.