OBJECTIVE: Minimally invasive aortic valve replacement (AVR) has been associated with several better outcomes over the standard full sternotomy approach. We revised our 10-year experience with right anterior minithoracotomy (RAMT) for AVR. METHODS: Between 2004 and 2014, a total of 593 patients (310 men; median age: 73.8 years) underwent AVR via RAMT. Preoperatively, a mixed valve lesion was diagnosed in 55 (9.3%) patients; and pure aortic regurgitation in 86 (14.5%). Mean logistic EuroSCORE I (European system for cardiac operative risk evaluation) was 7.4 (median: 5.76). RESULTS: In 302 (50.9%) patients, a sutureless or rapidly implantable biological prosthesis was used; in 23 (3.9%), a mechanical prosthesis; and in the remainder, a conventional biological prosthesis. A total of 113 (19.1%) patients had a small aortic annulus (≤21 mm). Operative times averaged 80 (median: 74) minutes of crossclamping time, and 117 (107) minutes of perfusion time; these were significantly shorter with a sutureless prostheses, compared with a sutured prostheses: perfusion 99 versus 134 minutes, P < .0005; aortic crossclamping time: 64 versus 97 minutes, P < .0005. The mean (median) assisted ventilation time was 9.8 (6) hours; intensive care unit stay was 1.5 (1) days; hospital length of stay was 6.6 (6) days. Overall in-hospital mortality was 9 deaths (1.5%). At 31.5 months mean follow-up time (1531 cumulative patient-years), 94.8% survival was observed. CONCLUSIONS: Minimally invasive AVR is a safe procedure, with low perioperative morbidity, and low rates of reoperation and death at late follow-up. Excellent outcomes can be achieved with minimally invasive AVR via right anterior minithoracotomy. Sutureless prostheses facilitate minimally invasive AVR and are associated with reduced operative times.
OBJECTIVE: Minimally invasive aortic valve replacement (AVR) has been associated with several better outcomes over the standard full sternotomy approach. We revised our 10-year experience with right anterior minithoracotomy (RAMT) for AVR. METHODS: Between 2004 and 2014, a total of 593 patients (310 men; median age: 73.8 years) underwent AVR via RAMT. Preoperatively, a mixed valve lesion was diagnosed in 55 (9.3%) patients; and pure aortic regurgitation in 86 (14.5%). Mean logistic EuroSCORE I (European system for cardiac operative risk evaluation) was 7.4 (median: 5.76). RESULTS: In 302 (50.9%) patients, a sutureless or rapidly implantable biological prosthesis was used; in 23 (3.9%), a mechanical prosthesis; and in the remainder, a conventional biological prosthesis. A total of 113 (19.1%) patients had a small aortic annulus (≤21 mm). Operative times averaged 80 (median: 74) minutes of crossclamping time, and 117 (107) minutes of perfusion time; these were significantly shorter with a sutureless prostheses, compared with a sutured prostheses: perfusion 99 versus 134 minutes, P < .0005; aortic crossclamping time: 64 versus 97 minutes, P < .0005. The mean (median) assisted ventilation time was 9.8 (6) hours; intensive care unit stay was 1.5 (1) days; hospital length of stay was 6.6 (6) days. Overall in-hospital mortality was 9 deaths (1.5%). At 31.5 months mean follow-up time (1531 cumulative patient-years), 94.8% survival was observed. CONCLUSIONS: Minimally invasive AVR is a safe procedure, with low perioperative morbidity, and low rates of reoperation and death at late follow-up. Excellent outcomes can be achieved with minimally invasive AVR via right anterior minithoracotomy. Sutureless prostheses facilitate minimally invasive AVR and are associated with reduced operative times.
Authors: Anna Olds; Siavash Saadat; Anthony Azzolini; Viktor Dombrovskiy; Karen Odroniec; Anthony Lemaire; Aziz Ghaly; Leonard Y Lee Journal: J Cardiothorac Surg Date: 2019-05-09 Impact factor: 1.637
Authors: Farid Foroutan; Gordon H Guyatt; Kathleen O'Brien; Eva Bain; Madeleine Stein; Sai Bhagra; Daegan Sit; Rakhshan Kamran; Yaping Chang; Tahira Devji; Hassan Mir; Veena Manja; Toni Schofield; Reed A Siemieniuk; Thomas Agoritsas; Rodrigo Bagur; Catherine M Otto; Per O Vandvik Journal: BMJ Date: 2016-09-28