International Society For Minimally Invasive Cardiothoracic Surgery

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Use Of Rapid Deployment Aortic Valve Via Right Anterior Thoracotomy; A Single Centre Experience.
Umar Imran Hamid, Giridhara Goli, Amir Sepehripour, Kulvinder Lall.
St Bartholomew's Hospital, London, United Kingdom.

Objectives: Aortic Valve Replacement (AVR) via minimally invasive approaches is increasingly being advocated not only due to better cosmesis but also due to less post-operative complications. The objective of this study was to report our experience of AVR via right anterior thoracotomy. Methods: Retrospective review of prospectively maintained database was carried out between July 2016 to September 2018 to identify patients who underwent AVR via right anterior thoracotomy. Sutureless aortic valve were used during surgery. Patient demographics, pre-operative, intra-operative and post-operative data were analysed. Results: 24 patients underwent AVR via right anterior thoracotomy during this period. Mean age was 75 +/-5.6. 38% were males. 30% were Diabetics. Mean BMI was 29 +/- 6.3. 93% had good LV function. Mean log Euroscore was 7.08 +/- 2.3. Mean clamp and bypass time were 46mins +/- 12 and 79 mins +/- 21 respectively. Two patients were converted to full sternotomy due to bleeding from right ventricle and unsuitable anatomy respectively. Two patients developed wound infections of the peripheral cannulation site. There were no infections in the thoracotomy wound. There were no re-operations for bleeding. Mean post-operative stay was 9 days. Two patients had post-operative stroke. 3 patients had paravalvular leaks (2 mild, 1 moderate). There were no in hospital mortalities. Conclusions: Aortic valve replacement via right anterior thoracotomy can be carried out with similar bypass and clamp times as conventional AVR using sutureless bioprosthesis, with low mortality however with higher morbidity as seen in the current patient series.

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