Impact Of Minimally Invasive Surgery By Rapid-deployment Aortic Valve Replacement
Iuliana Coti, MD, Stephane Mahr, MD, Alfred Kocher, MD PhD, Martin Andreas, MD PhD, Mislav Planinc, MD, Shiva Shabanian, PhD, Thomas Aschacher, MD, Thomas Haberl, MD, Guenther Laufer, MD PhD.
Medical University of Vienna, Vienna, Austria.
OBJECTIVE: Minimally invasive aortic valve replacement (MI-AVR) was performed for the first time in 1993. The implantation of an aortic valve through this approach in today’s clinical practice is still rare. We examined the impact of MI-AVR in all patients who received a rapid-deployment aortic valve (RD-AVR) at our centre.
METHODS: We enrolled 422 consecutive patients in whom RD-AVR was implanted from May 2010 until December 2016 at our institution. The postoperative outcome and survival were analysed. Implementation of RD-AVR in minimally invasive surgical approach was examined. Due to the learning curve in the first two years RD-AVR was exclusively done through full sternotomy. Beginning from 2012 RD-AVR with minimally invasive approach was increasingly used and is now the standard technique for all patients with indication for an isolated AVR.
RESULTS: Between May 2010 and December 2016, 422 patients received an RD-AVR. Among these patients, 44% (n=186) were operated through a minimally invasive approach, out of which 48% (n=92) were operated through an upper hemisternotomy and 52% (n=94) through an anterior right thoracotomy. Intraoperatively, 3 patients (1.6%) were converted to median sternotomy due to bleeding. Isolated AVR was performed in 84% of patients operated through a MI technique. Concomitant procedures done with MI approach were aortic reduction plasty for ascending aortic dilatation and decalcification of calcified anterior mitral leaflet. The perioperative mortality for the minimally invasive cases was 0.53% (n=1) and overall mortality was 1,61% (n=3).
CONCLUSIONS: The implantation of an RD-AV through a minimally invasive approach in selected patients with aortic valve stenosis has shown excellent results concerning early and late mortality. This approach is increasingly used and tends to completely replace full sternotomy for patients in whom an isolated AVR is required. <!--EndFragment-->
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