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OBJECTIVE: Aortic valve replacement (AVR) through anterior right thoracotomy (ART) using a rapid deployment valve combines two surgical innovations that despite technical challenge might have a beneficial effect on patients with severe aortic stenosis. In this study we revised our experience.
METHODS: Between April 2011 and November 2015, 76 patients (39 male, 51.3%) mean age 73±10 years underwent AVR for severe aortic stenosis through ART with an eight centimeter skin incision using direct cannulation of the aorta and the right atrium. Mean logistic EuroSCORE and EuroSCORE II was 6.9 (±5.3) and 2.3 (±2.1) respectively.
RESULTS: Implantation of the rapid deployment valve was successful in all patients using ART. Mean crossclamp time and perfusion time was 86.8 and 123.6 minutes respectively. A total of 30 patients (39.4%) had an annulus of ≤21mm with the most common implanted prosthesis size being 21mm (n=22, 28.9%). One major bleeding event (1.3%) necessitating rethoracotomy occurred immediately after the patient was transferred to the ICU postoperatively. In one patient (1.3%) a stroke occurred while no transient ischemic attack was observed. No other valve related complications were observed such as valve thrombosis, valve endocarditis, or reoperation due to structural and nonstructural valve deterioration. Mean and peak prosthesis gradient at discharge were 14.1mmHg (±4.8) and 25.5mmHg (±8.5) respectively. Permanent pacemaker dependency with postoperative implantation of a pacemaker was 13.2% (n=10). Thirty-day mortality was 1.3% (n=1), while overall mortality was 2.7% (n=2).
CONCLUSIONS: Despite a higher than expected permanent pacemaker rate, overall results show a safe and feasible implantation technique using ART with a rapid deployment valve with a remarkably low complication and mortality rate.