Right Minithoracotomy for Concomitant Aortic Valve Replacement and Right Coronary Artery Bypass Graft
Chu Dijon, Dijon, France
Objectives For years, full sternotomy was the standard approach for combined surgery. But evidence about minimally invasive thoracotomy advantages for aortic and mitral valve replacement gets stronger. It is in this way that we began to propose minithoracotomy for the elective patient presenting aortic valve stenosis associated with right coronary artery disease. Methods Between January 2016 and February 2020, 14 patients underwent a concomitant aortic valve replacement and right coronary artery bypass grafting through a minimally invasive right anterior thoracotomy. Results The average age was 73.5 years, and the mean Euroscore 2 was 2.05±1.23. The average cardiopulmonary bypass and aortic cross-clamp times were 145±30 minutes, and 109±19.7 minutes, respectively. Eleven patients (78.6%) benefited from femoral cannulation. Artery grafts were made with the saphenous vein (n=9; 64%) or the right internal thoracic artery (n=5; 36%), and for the last nine patient ultrasonic flow measurements was used to control the graft. The mean postoperative transvalvular gradient was 9.4±4 mmHg, [2-16]. Two patients presented a grade 1 aortic insufficiency (7%). There was no 30Days mortality. Surgery efficiency was assessed by postoperative transthoracic echocardiography, stress test at 3 months and one year clinical follow up. Conclusions Combined aortic valve replacement and right coronary artery bypass grafting through anterior right thoracotomy is reliable and reproducible in selected patients. The technic can be even improved by smart devices: Cor Knot fasteners, mainly robotic-assisted internal thoracic artery harvesting).