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International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Redo AVR Through Right Anterior Thoracotomy
Moritz C. Wyler von Ballmoos, MD, PhD, MPH, Mahesh K. Ramchandani, MD, FRCS.
Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.

BACKGROUND - Minimally invasive aortic valve replacement through a right anterior thoracotomy (RAT) is now done routinely by many surgeons. Although some consider previous cardiac surgery a contraindication for this approach, patients who had a previous sternotomy may particularly benefit from this sternal-sparing and minimally invasive approach.
METHODS - With present a detailed, step-by-step video of how to safely and efficiently perform a redo-AVR using the RAT approach. Using the example of a 58-year-old M who underwent SAVR using a bioprosthetic valve 20 years earlier and presented with severe SVD this video showcases the tips and tricks of how to gain exposure in a redo-setting, explant the previous valve and replace it using a rapid-deployment valve.
RESULTS - As is the case with the RAT approach to SAVR in a first-time surgery, patients have excellent outcomes, can be extubated in the OR, and have a quick functional recovery after redo-AVR through the RAT.
CONCLUSIONS - Previous cardiac surgery is not a contraindication to SAVR through a RAT. Several tips & trick help with obtaining exposure that is no different than in first-time MICS cases to allow these patients to benefit from a faster recovery.


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