No-rib Spreading Video Assisted Right Minithoracotomy Avr: A Study Design From The Endoscopic Avr Collaborative Group
Marco VOLA1, Bob Kiaii2, Mauro Rinaldi3, Mattia Glauber4, Antonio Miceli4, Tommaso Hinna Danesi5, Loris Salvador5, GIovanni Marchetto3, Sadia Batool1, Tony Aoun1, Erik Cura Stura3.
1Lyon University of Medicine, LYON, France, 2London Health Sciences Centre, LONDON, ON, Canada, 3Turin University Hospital, TURIN, Italy, 4Istituto Clinico Sant'Ambrogio, MILAN, Italy, 5San Bortolo Hospital, VICENZA, Italy.
BACKGROUND : No rib-spreading and video assisted right anterior minithoracotomy aortic valve replacement (AVR) is an approach that is currently adopted by centers experienced in right anterior minithoracotomy aortic valve surgery. The effort of this Endoscopic AVR collaborative group is to analyze results of AVR performed with the lowest degree of invasiveness, by trained teams and in low and intermediate risk patients. METHODS : This is a multicentric retrospective study with a prospective data collection protocol. Centers, with surgeons who have an experience of at least 20 AVR's performed through right anterior minithoratotomies with the use of a rib retractor, were contacted to include patients in the study. Main technical features of the protocol are : avoidance of a rib retractor and exclusive use of a soft tissue retractor with a limited skin incision (< 6 cm ); use of femoro-femoral peripheral cardiopulmonary bypass(CPB), use of fiberoptics introduced laterally to the minithoracotomy (2nd space) , Carbon dioxide insufflation and Transesophageal echocardiogram for perioperative monitoring, use of sutureless or rapid deployment or sutured valve prosthesis with or without automated knotting devices. Exclusion criteria were: preoperative CT scan showing a short ascending aorta (intrapericardial ascending aorta < 6 cm), calcifications of ascending aorta at the site of cross clamping and at the site of the aortotomy, inadequacy for safe peripheral retrograde CPB (due to occlusive or aneurysmal peripheral vessels); redo Surgery, reconstructive surgery of the aortic annulus, and requirement of associated surgery of the ascending aorta . Early post-operative life quality assessments (SF -12, I.A.D.L. scale) are included in the protocol. RESULTS : Six centers have formally accepted to participate in the study and data are being processed since Jannaury 2018 . A target of 200 patients is planned to be included in the study. CONCLUSIONS : This is a first initiative step before designing a study comparing this patient subset to similar patients who have undergone transcatheter aortic valve Implantation. Early results of over 60 patients will be included and presented.
LEGEND: Image 1 : Second space no rib-spreading right anterior minithoracotomy ( left) and video assisted aortic valve debridment ( right) 
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