Right Minithoracotomy For Aortic Valve Replacement In 519 Patients
Mauro Del Giglio, Elisa Mikus, Roberto Nerla, Simone Calvi, Antonio Micari, Alberto Cremonesi.
Maria Cecilia Hospital, GVM for Care & Research, Cotignola (Ra), Italy.
OBJECTIVE: Over the past decade, minimally invasive cardiac surgery has emerged as a valid alternative to treat aortic valve disease. Various techniques have been developed but surgeons seem to prefer a partial sternotomy instead of right mini-thoracotomy approach. Longer cardiopulmonary bypass time and need for peripheral cannulation are the main disadvantages reported in literature in case of minithoracotomy. The aim of this retrospective study is to discuss clinical results in more than 500 patients treated with right minithoracotomy approach and to show that these pitfalls can be solved
METHODS: From January 2010 to June 2016, a total of 519 adult patients underwent isolated aortic valve replacement through a right minithoracotomy in two separate cardiac centres managed by one single team of Cardiac Surgeons. There were 286 male (55.1%) with a mean age of 71.7 ± 11.9 years (range 16-93). The Body Mass Index mean was 26.9 ± 4.5 kg/m2 (range 17.3-52.7) and mean Logistic EuroSCORE about 6.3 ± 4.2% (range 0.88-34.48%). Only one patient was previously operated.
RESULTS: Minimally invasive aortic valve replacement was successfully performed through a 4 to 6 cm long right minithoracotomy at the third intercostal space without rib avulsion or ligation of the right internal mammary artery. All patients received an aortic valve replacement implanrted using three 2-0 prolene running sutures (median prosthesis implanted 23 mm diameter) with total central cannulation in more than 400 patients. Overall mean cardiopulmonary bypass was 60.5 ± 19.9 minutes and aortic cross clamping was 47.8 ± 16.1 minutes. Median ventilation time and intensive care stay were 7 hours and 1.7 days. In-hospital mortality was 1.3% (7/519).
CONCLUSIONS: After 6 years experience with right minithoracomy approach for isolated aortic valve replacement it is possible to assert that central cannulation can be easily used and operative times are competitive with those reported with other approaches. Rib avulsion and right mammary artery ligation are not necessary as well preoperative CT scan. The only real exclusion criteria is a previous left pneumectomy.. Advantages include early mobilization and rehabilitation, excellent aesthetic result and lower risk of wound complications. In conclusion: why not?
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