Back to 2017 Cardiac Track Overview

OBJECTIVE: Minimally invasive aortic valve replacement (MIAVR) through a right anterior minithoracotomy evolved to an widespread adopted procedure. A full endoscopic MIAVR surgery, named Endoscopic Cardiac Surgery is adopted by few centers. The aim of this study is to evaluate early outcomes of MIAVR performed in a completely thoracoscopic fashion regardless the type of prosthetic valve implanted.
METHODS: From April 2013 to September 2016 54 consecutive patients without any selection underwent full thoracoscopic MIAVR. Mean age was 69.9 ± 10.8 years and median EuroScore (logistic) was 5 (1.51-15). Baseline characteristics, intraoperative and in-hospital outcomes were collected and analyzed.
RESULTS: In this study, 2 patient were redo. In 12 patients a Sorin Perceval S sutureless bioprosthesis was implanted, in 7 an Edwards Lifescience rapid deployment Intuity Elite bioprosthesis and in 34 patients a stented standard bioprosthesis (17 Medtronic Mosaic Ultra porcine valve and 17 other types). Associated procedure were 1 mitral valve repair and 2 tricuspid valvuloplasty. Mean CPB time and Aortic cross clamp time were 136 ± 37.4 and 96 ± 23.9 minutes respectively; in sutureless and rapid deployment bioprostheses were respectively 136 ± 55.3 and 88.9 ± 29.3 minutes. Mean ventilation time and ICU stay were 15.9 ± 40 and 60.6 ± 70.7 hours (median 4.5 and 42 hours respectively).30 day mortality was 3.7% (2/54), and there was no permanent stroke, no conversion to full sternotomy and no aortic dissection.
CONCLUSIONS: Full endoscopic MIAVR is safe and feasible with favorable early outcomes. The choice of the prosthesis does not influence the operating time. In the future, it could serve as benchmark for interventional methods. Randomized studies are needed to compare the long-term outcomes of these approaches.