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Right Mini-Thoracotomy Approach For Isolated Aortic Valve Replacement With Total Central Cannulation: Is It The Way To A New Standard?
Mauro Del Giglio1, Simone Turci1, Corrado Bentini1, Simone Calvi2, Elisa Mikus2.
1Villa Torri Hospital, Bologna, Italy, 2Maria Cecilia Hospital, Cotignola, Italy.

OBJECTIVE: Minimally invasive surgical techniques have been developed for treating many cardiac diseases. Minimally Invasive Aortic Valve Replacement (MIAVR) through a right mini-thoracotomy is not widespread because it is limited by the very tiny operating field, the need for a peripherical cannulation and the longer cardiopulmonary bypass time compared to the standard approach. The purpose of this study is to review our initial experience with MIAVR through a right mini-thoracotomy with total central cannulation.
METHODS: Between January 2010 and December 2012 116 patients underwent MIAVR through a 4- to 6 cm skin incision at the third intercostal space without rib resection. In the last 70 consecutive patients - mean age 72.7 ± 10.3 years - the cardiopulmonary bypass was instituted through the same surgical access. The aortic cross clamp has been placed trancutaneously just above the main skin incision and cold blood antegrade cardioplegia has been used in all cases.
RESULTS: All patients received an isolated aortic valve replacement with a median prosthesis size of 25 mm. Mean cardiopulmonary bypass time and cross-clamp time were respectively 62.5 ± 13.5 min and 49.8 ± 12.1 min. Skin-to-skin time was 178.2 ± 35.4 minutes. Median post-operative ventilation time was 7 hours and intensive care and hospital stay were respectively 1.7 days and 8 days. No deaths have been recorded. One patient has been revised for wound complication and in one case a pacemaker implantation was needed for complete atrio-ventricular block.
CONCLUSIONS: Our experience confirms that MIAVR achieved through a right mini-thoracotomy with central cannulation is safe and it can be easily performed without increasing the surgical time if compared with the standard full sternotomy approach at our department and avoiding groin incisions. The advantages of this technique include early mobilization and rehabilitation, excellent aesthetic result and lower risk of wound complications.


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