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Minimally Invasive Avr Via Anterior Right Thoracotomy (art); A Safe And Effective Approach
Anas Ahmad, MAZHAR UR REHMAN;
Omer hospital and cardiac center, LAHORE, Pakistan
BACKGROUND: Minimally invasive approach has evolved into a safe, well-tolerated and effective surgical option for aortic valve replacement in recent years. Four different approaches are used for minimally invasive aortic valve replacement. These include right parasternal, transverse sternotomy, anterior right thoracotomy and upper J or T shaped hemisternotomy. In this study anterior right thoracotomy(ART) via 2
nd intercostal space with peripheral cannulation (femorofemoral CPB) was our preferred approach. We compared postoperative outcomes with this technique to median complete sternotomy (MCS) in conventional AVR.
METHODS: From Dec 2020 - Jan 2022, 32 patients underwent aortic valve replacement. We divided these patients in two groups. Group A MIAVR included 16 patients and Group B conventional AVR included 16 patients. Patient data was collected and analyzed using IBM SPSS statistic 21 and chi squared test was applied to assess the variables. We presented variables under study as numbers, percentages and interquartile range.
RESULTS: In group A right anterior mini thoracotomy through 2
nd intercostal space was used while in group B median complete sternotomy was done. Mortality and morbidity rates were similar in both groups. Incidence of stroke was similar in both groups. MIAVR was associated with longer CPB time (88 (70-158) vs 63.5 (80-143.5) mins with almost comparable Aortic cross clamp time (47.25(49.75-97) vs 49(45.5-94.5) min. MIAVR was associated with less bleeding therefore decreased blood product requirement 31.2% in group A vs 62.5% in group B. MIAVR group had less ventilation time (2.43(2-4.43) vs 4( 3-7)hours and shorter ICU stay (1.25 (1.65 - 2.875) vs 3( 2-5) days. Overall hospital stay was also reduced in MIAVR i.e 4 days vs 7 days in group B. chest drain removal ( mean 1.5 vs 3 days). Early mobilization owing to better sternal and thoracic stability alongwith less postoperative pain contributes to faster recovery. Improved cosmesis associated with smaller incision remains an unquestionable benefit of MIAVR.
CONCLUSIONS:MIAVR is associated with less transfusion requirement, shorter hospital stay because of less ventilation time, early mobilization, less postoperative pain leading to rapid postoperative recovery but has an increased overall operation time.
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