Right Anterior Minithoracotomy For Aortic Valve Replacement: Early Outcome Of A Single Center
Samuel Bruls, MD, Jean-Paul Lavigne, PhD, Vincent Tchana-Sato, MD, Danae Halleux, MD, Rodolphe Durieux, MD, Quentin Desiron, MD, Gregory Hans, PhD, Jean-Olivier Defraigne, PhD.
CHU Liege, Liege, Belgium.
ObjectiveAortic valve replacement (AVR) through a right mini-thoracotomy (RAMT) is technically more complicated. However, its potential benefits include less postoperative pain, blood loss and transfusion, with a faster recovery. We report our early experience of aortic valve replacement through a RAMT. MethodsFrom mars 2017 to November 2019, a total of 78 patients were selected to undergo an AVR via RAMT. Complete procedures were achieved in 71 patients through a small 5cm RAMT in the second or third intercostal space. Cardiopulmonary bypass was established through the femoral vessels. Preoperative diagnoses were aortic valve stenosis (n=68), insufficiency (n=2) and endocarditis, (n=1). ResultsReason for conversion to sternotomy was: severe pleural adhesions (n=2), aortic root enlargement to avoiding patient-prosthesis mismatch (n=2), femoral cannulation management problem (n=2), right coronary ischemia (n=1) and poor exposure (n=1). All patients requiring conversion to sternotomy were observed during the beginning of our experience (the first eight months). For the 71 patients who undergone complete AVR through RAMT, the mean age was 71 years (ranging from 42 to 90) including 40 male and 33 female patients. 45 patients benefit from a conventional bioprosthesis, 19 patients a sutureless bioprosthesis and 7 patients a mechanical prosthesis. The mean aortic cross-clamp and cardiopulmonary bypass time was 71 and 112 minutes respectively. Median intensive care unit and hospital stay were 2 and 6,5 days respectively. At discharge, 74% of the patients back home directly. In hospital mortality was 4,2%. ConclusionsMinimally invasive AVR through a right mini-thoracotomy, even if more technically complicated, is a safe and reproducible approach. The benefit is well know: a lower rate of postoperative pain, blood loss and transfusion, with a faster recovery and a more aesthetic incision. After a mentoring programme and a learning curve, experienced surgeons could replace standard sternotomy with a RAMT approach.
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