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OBJECTIVE: To evaluate surgical feasibility and clinical outcome of sutureless aortic valve replacement (SAVR) in patients (pts) using a minimally-invasive approach via anterolateral thoracotomy.
METHODS: In pts with severe and isolated aortic valve stenosis cardiopulmonary bypass (CPB) was installed by femoral cannulation. After right-sided anterolateral minithoracotomy AVR was performed using two different types of sutureless aortic valves prostheses. Surgical key times and clinical outcome were assessed. Echocardiography was performed during surgery, before discharge, and during follow-up exams each year.
RESULTS: Overall, 21 pts underwent SAVR via minimally-invasive approach (m:w = 10:11), mean age 76.1 ys (range 68-88 ys). Mean Euroscore was 11.1 (range 4.3 - 24.2). Mean cross clamp time was 46.2 mins (range 29-70 mins), mean CPB time was 82.4 mins (range 58 - 113 mins). Prostheses sizes of 23 and 25 mm were used in most pts (n=7 and 5, respectively).
In a comparable cohort of isolated SAVR pts with full sternotomy approach aortic cross clamp time was lower (mean X clamp time 40.1 mins (19-63 mins; statistically n.s.). Echocardiographic examinations did reveal no paravalvular leakage (lvl) in all pts and low pressure gradients (overall mean 10,1 mmHg). There was one postoperative death due to respiratory failure (day 19). Postoperative pacemaker implantation due to new-onset bradycardia was necessary in 1 pt. During mean follow-up time of 355 days (range 13 to 693 days) no further significant complication was observed. Follow-up echocardiographic examination did not reveal any new onset of pvL. Mean pressure gradient was 7.9 mmHg (5-11.5 mmHg) on average and remained low over time.
CONCLUSIONS: In our preliminary experience with minimally-invasive SAVR via minithoracotomy surgical key times, hemodynamic and clinical outcome did not differ from patients with SAVR via full sternotomy. The unique properties of suture less aortic valves facilitates minimally-invasive access to the aortic valve resulting in safe and faster SAVR compared to conventional heart valves.