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International Society For Minimally Invasive Cardiothoracic Surgery

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Aortic Valve Replacement Trough Right Minitoracotomy - The Alternative For Tavi And Sternotomy Avr In High Risk Patients
Anna Kwiecien, Tomasz Hrapkowicz, Michał Kręt, Jan Głowacki, Jerzy Foremny, Michał O. Zembala.
Silesian Center for Heart Disease, Zabrze, Poland.

Introduction
Minimally invasive aortic valve implantation without sternotomy is an alternative to classic cardiac surgery and for TAVI, especially for procedures high-risk patients. In this study, we present preliminary results and discuss the most important aspects and pitfalls of the learning curve of MT-AVR.
Material
In the period of two years (2018-2019), 25 aortic valve replacement procedures trough out minitoracotomy (MT-AVR) were performed in our center. Among the operated patients were 13 women (52%), the age of the patients ranged from 43-77 years (average 63 +/- 8) and BMI 22 - 47 (22 +/- 5.9), of which 50% of patients belonged to the group of obese patients. EuroSCORE operational risk was 4.3% (+/- 2).
Results
Aortic valve replacement was performed via II or III intercostal space ( 4 - 5 cm skin incision) using extracorporeal circulation by cannulation of the femoral artery and vein. Aortic valve prostheses (64% biological prosthesis) were implanted using a semi-continuous suture method. In all patients del Nido cardioplegia protocol was used. Median extracorporeal circulation time was 150 minutes and aortic clamp - 106 minutes. There was no patient death, one patient required reoperation due to perivalvular leak and one due to increased postoperative drainage. The mean postoperative drainage was 280ml. During early postoperative period 5 patients needed the norepinephrine infusion to maintain arterial pressure, however any patients needed other catecholamines. The average length of stay in the ward was 5.1 (+/- 1.6) days.
Conclusions
Aortic valve replacement procedures through minithoracotomy are procedures with a higher degree of difficulty than other minimally invasive approaches. Appropriate selection of patients allows this type of intervention to be carried out on patients in whom classic surgery may be associated with sternum incision dependet complications (e.g. BMI 47). The longer circulatory and aortic cross clamp time in our preliminary material is certainly related to the learning curve, however, it does not affects the early results.


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