Valve-sparing Sternum-sparing Robotic Assisted Resection Of Aortic Valve Fibroelastoma
Diego Avella, Brooke Patel, Mackenzie McCrorey, Husam H. Balkhy.
University of Chicago, Chicago, IL, USA.
OBJECTIVE: When feasible, valve-preserving resection of an aortic fibroelastoma is the ideal therapeutic approach. Traditionally, full median sternotomy has been the most common surgical approach. Here we report a series of three patients who underwent valve-sparing, sternum-sparing robotic-assisted resection of an aortic valve fibroelastoma.
METHODS: A retrospective chart review of the three patients was performed. Perioperative variables and outcomes were collected.
RESULTS: Three patients (two females and one male) were found to have an incidental mass on the non-coronary aortic valve leaflets consistent with fibroelastoma. Patient 1 (42 F) had no prior cardiac comorbidities. Patient 2 (69 F) had two prior cardiac surgical procedures (for atrial fibrillation ablation and MV repair respectively). She underwent concomitant dissection of significant cardiac and right lung adhesions. Patient 3 (79 M) underwent concomitant AF ablation at the time of surgery. Operative technique: Three robotic ports were placed in the first, second and fourth intercostal spaces, and a 3 cm non rib-spreading working port was placed in the second intercostal space lateral to the camera port. Femoro-femoral cannulation for cardiopulmonary bypass (CPB) was utilized. A Chitwood aortic clamp was applied for cardiac arrest and antegrade Del Nido cardioplegia solution was given via a catheter placed through the working port. The mass was excised using sharp dissection and low electrocautery. The largest diameter of each of the masses measured 9, 8 and 5 millimeters respectively. Surgical time was 240 minutes and mean CPB time was 122 minutes. The trans-esophageal echocardiogram confirmed complete resection and no aortic insufficiency. There were no postoperative complications. All patients stayed in the intensive care unit for one night and were discharged home on postoperative day 3 or 4.
CONCLUSIONS: Valve-sparing, sternum-sparing robotic-assisted excision of an aortic fibroelastoma is feasible. In comparison to a complete or partial trans-sternal approach, the preliminary results of this series suggest equivalent operative success with shorter lengths of stay. This approach may have implications for robotic-assisted aortic valve replacement with sutureless valves
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