Minimally invasive sutureless aortic valve replacement with Perceval valve through the right lateral thoracotomy
Yoshitsugu Nakamura, Takuya Narita.
Chibanishi General Hospital, Department of Cardiovascular Surgery, Kanegasaku, Japan.
BACKGROUND: Minimally invasive sutureless aortic valve replacement with Perceval valve (MISAVR) is commonly performed through the right anterior thoracotomy (AT), however, the lateral thoracotomy (LT) has several advantages over AT such as no-need of cutting of the right internal thoracic artery (RITA) or rib, or cosmetic benefits. The aim of this study to evaluate feasibility and effectiveness of MISAVR through LT by comparing through AT METHODS: We retrospectively reviewed 38 MISAVRs performed from May 2019 to August 2021 and compared the outcomes of patients undergoing MISAVR through LT (Group L, n=21) with MISAVR through AT (Group A, n=17). In Group L, 5 cm skin incision on the right anterior axillary line and the 3rd intercostal thoracotomy were used for access, while in group A, 6 cm skin incision on the right anterior chest and 2nd or 3rd intercostal thoracotomy were used depending on patients’ anatomy. Techniques of AVR and cannulation methods for cardiopulmonary bypass were same in both groups.RESULTS: Patients’ characteristics including age, body surface area, EuroSCORE II, ejection fraction were similar in both groups. Procedure time (L: 157 +/- 46 vs. A: 181 +/- 42, P=0.12), CPB time (L: 82 +/- 19, vs. A: 93 +/- 28, P=0.19) and cross clamp time (L: 57 +/- 13, vs. A: 64 +/- 23, P=0.19) were not significantly different in both groups. Rib and RITA cutting were required more in Group A (L: 0 vs. A: 14 (82.4%), P<0.001). There was no hospital mortality, stroke, nor complete atrioventricular block in either group. There was no significant difference of total amount of chest tube output ((L: 472+/- 398, vs. A: 422 +/- 351, P=0.68). Duration of hospital stay was similar in (L: 10.3 +/- 3.1, vs. A: 11.6 +/- 4.2, P=0.30). Transthroacic echo cardiogram showed no perivalvular leak in both groups. CONCLUSIONS: MISAVR through LT is feasible and effective approach in terms of damage reduction on chest wall compared to AT.
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