International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive BioBentall Procedure With Edwards Inspiris Valve: Our Treatment In Complex Root Pathology When The Valve Is Not Repairable
Gabriele Tamagnini1, Marianna Nardozza1, Marco Paris1, Carla Beggino1, Liborio Mammana2, Matteo Saccocci1, Elisa Mikus3, Josč Luis Zulueta1, Mauro Del Giglio1.
1Istituto Clinico San Rocco, Ome, Italy, 2Istituto Clinico Sant'Ambrogio, Milano, Italy, 3Maria Cecilia Hospital, Cotignola, Italy.

Background: Upper ministernotomy has become a common approach for surgical aortic valve replacement but it has been rarely used for complex aortic procedures. We've adopted this approach in more than 260 Bentall and David procedures since 2010. We describe our 2018 experience in the mini-Bentall procedure in young patients with the bioprosthesis Edwards Inspiris. Methods: From January 2018 to October 2018, our group has treated 28 Patients with Bentall procedure via minimally-invasive upper ministernotomy from the notch to the 3rd right intercostal space using a self-sewed bioconduit with the Edwards Inspiris prosthesis. All the patients who have been enrolled in this study were not suitable for aortic valve repair or sparing procedures and they chose not to receive a mechanical prosthesis. Our ultra fast track anesthesia protocol was applied, aiming to extubate the patient within 3 hours. Results: All procedures went successfully. Complete central cannulation (arterial = distal ascending aorta, vein = atrial appendage) has been used in every case. Baseline characteristics: male 92%; mean age of 52 ± 13.3 yrs; mean STS Risk Score of Mortality 2,13 % ± 0,71% and of Morbidity/Mortality 12,95% ± 4,65%. Results: median implanted prosthesis diameter was 27 mm (mean size 26,1 mm); mean CPB duration was 67 ± 20,6 minutes; aortic cross-clamping time was 57 ± 16,5 minutes; median ventilation time was 3 hrs; median ICU stay 2 days. 25 % patients needed blood transfusion (median number of bags: 3). The total in-hospital stay median duration was 12 days. Observed 30-day mortality rate was 0%. At discharge, no paravalvular aortic regurgitation was observed and the mean transaortic gradient was 7.9 ± 2.1 mmHg. At 3 month follow-up, mortality rate was 0% and the mean transaortic gradient was 6.5 ± 2.5 mmHg. Conclusion: Our experience confirms that minimal invasiveness can be successfully achieved also in Bentall procedures. Regarding young and active patients, Edwards Inspiris bioprosthesis is the ideal solution when the native valve can't be saved and the patient prefers a biological prosthesis. The bioBentall procedure via partial upper ministernotomy could be an attractive and safe alternative for selected patients affected by complex aortic root pathology.

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