Minimally Invasive Aortic Valve Reoperation. The Maria Cecilia Hospital Experience
Elisa Mikus1, Simone Calvi1, Mauro Del Giglio2, Diego Magnano1, Marco Pagliaro1, Alberto Albertini1.
1Maria Cecilia Hospital, GVM for Care & Research, Cotignola (Ra), Italy, 2Villa Torri Hospital, GVM for Care & Research, Bologna, Italy.
Background: Aortic valve replacement through an upper "J" sternotomy approach has been widely described in literature with excellent results. Otherwise, reoperative aortic valve surgery is currently being performed by the same minimally invasive access only in few centers. We describe our experience using a minimally invasive approach for redo aortic valve reoperation, using both minithoracotomy or ministernotomy approaches. Methods: Between June 2007 and December 2017 a total of 233 consecutive adult patients underwent reoperative isolated aortic valve replacement at our Institution. Eighty-two of them had minimally invasive approaches through a ministernotomy (n°=76) or a right minithoracotomy (n°=6). There were 54 male (66 %) with a mean age of 69.7±12.5 years (range: 30-84 years), with mean Euroscore of 10±3. Fourty-two patients had patent bypass grafts. Nine patients had endocarditis as aetiology. Results: A total central cannulation was preferred in 75 patients (91%). Mean cardiopulmonary bypass time and mean cross-clamp time were respectively 69±27 min and 54± 24 min. Hospital mortality was 3.6% (3/82). Conclusions: Minimally invasive surgery means to reduce biological aggressiveness through short surgery operating time, less blood loos and lower risk of sternal instability or infection. Both approaches proved to be safe, reproducible and meets all requirements for a minimally invasive surgery
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