International Society For Minimally Invasive Cardiothoracic Surgery

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Safe And Widely Applicable Minimally Invasive Aortic Valve Replacement Using Continuous Retrograde Cardioplegia And Anterior Thoracotomy
Shunsuke Sato, Takashi Azami.
Yodogawa Chiristian Hospital, Osaka, Japan.

BACKGROUND: Minimally invasive aortic valve replacement through thoracotomy (MICS AVR) has difficulties due to complication of selective cardioplegic perfusion and difficulty of tie-down of biological valve to aortic annulus. We present a safe approach of MICS AVR using continuous retrograde cardioplegia through anterior thoracotomy. Continuous retrograde cardioplegia allows excellent continuous homogenous cooling of the heart during the ischemic period. Anterior thoracotomy facilitates cannulation of ascending aorta, and allows our all manipulations using the fingertips without the aid of a knot pusher or long-shafted surgical instruments. METHODS: We entered thoracic space through anterior 3rd intercostal space with resection of 4th costal cartilage, and resection of 3rd costal cartilage if aortic cannulation was required. Cardiopulmonary bypass was established with the femoral artery /or the ascending aorta, and the right femoral vein and inferior vena-cava. After clamping of ascending aorta, right atrium was opened and continuous retrograde cardioplegia was administered through a coronary sinus cannula. Ultrafiltration was used during cardiopulmonary bypass. We performed MICS AVR using this method in 5 patients between June 2018 and November 2018. There were 3 women. Median age of patients was 71 years (range: 43-77 years). Femoral artery cannulation was performed in 2 cases, and ascending aorta in 3 cases. Two patients required ascending aortic cannulation because of having shaggy descending aorta, and one patient hading severe atherosclerosis obliterans. One patient required patch plasty of Valsalva sinus because of severe calcification on ascending aorta. RESULTS: There was no patient requiring defibrillation or extra weaning time after declamping of aorta. Knot-pusher was not required. Two patients were extubated in operative theater. Hospital stay was 8-14 (median 12) days after operation. There was no hospital death. CONCLUSIONS: MICS AVR using continuous retrograde cardioplegia is safe technique.

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