Aortic Valve Replacement Through A Right Mini-thoracotomy With Total Central Cannulation. Single Center 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 a right mini-thoracotomy is a minimally invasive procedure not frequently used because of have been reported longer cardiopulmonary bypass and cross clamping times compared to the standard full sternotomy.METHODS We reviewed 634 patients (350 male 55% with median age of 75; range 16-93 years) who received an aortic valve replacement between January 2010 and April 2018 through a right mini-thoracotomy A total central cannulation was preferred in more than 90% of patients. The maiority received an aortic valve replacement with a pericardial bioprothesis sutured using three 2/0 prolene running sutures or more recently a sutureless prosthesis (80 patients; 12%). Mean prosthesis size was 24 mmRESULTS Aortic replacement was performed through a 4 to 6 cm skin incision at the third intercostal space. Six patients were a REDO case. Overall median cardiopulmonary bypass and aortic cross clamping time was respectively 58.5 minutes (range 25-172) and 46 minutes (range 16-134). Median ventilation time and intensive care stay were 7 and 44 hours. Patients transfused were 42%. Hospital mortality was 1.4% (9/634). CONCLUSIONS This single cenetr experience show that aortic valve replacement achieved through a right mini-thoracotomy is a safe procedure with excellent results. Thanks to a standardized technique cardiopulmonary bypass and cross-Clamping times comparable with the standard can be obtained and peripheral cannulation avoided
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