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Objective: To evaluate the feasibility and advantages of minimally invasive implantation of a sutureless aortic valve prosthesis
Methods: Since July 2010, sutureless aortic valve implantation (SAVR) has been performed in total 97 patients in our institution. From this, 51 patients underwent isolated aortic valve replacement. In one third, surgical access was performed by partial sternotomy (n=13) or anterolateral minithoracotomy (n=4). Duration of operation, bypass and cross clamp time were taken and compared with the corresponding patient cohort of SAVR without minimally invasive surgical access. Peak and mean pressure gradients across the valve prosthesis were detected at the time of operation or before discharge.
Results: Of the SAVR patients operated minimal invasively, 13 of 17 were male. Mean age was 80,5 yrs (range 74 -88 yrs) compared to the non-minimal invasive (non-MI) patient group (n=34): mean age 76,4 yrs (range 66-89 yrs). Intraoperative surgical key times were significantly shorter in non-MI patients: mean cross clamp time was 33 mins (18-60 mins) vs mean 46 mins (38-64 mins), bypass time in non-MI patients was mean 52 mins (41-114 mins) vs mean 62 mins (50-108 mins). One patient in each group underwent a second intraoperative valve placement due to initial paravalvular leakage. Postoperatively, one pt died in the MI group, two pts in the non-MI group, all due to non-valve related reasons. Peak and mean pressure gradients were very low and comparable between both groups.
Conclusions: Aortic valve replacement through a small surgical access is feasible and results in similar clinical outcome compared to patients with full sternotomy. The feature of suturelessness facilitates the implantation procedure and sets up novel surgical strategies such as a small lateral thoraocotomy. Future redesign of the valve prosthesis itself and the deployment procedure will show whether comparable cross clamp and bypass times are achievable.