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STS 2013: AVR Via Right Mini-Thoracotomy

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Purpose: The adoption of Minimally Invasive Aortic Valve Replacement (MIAVR) through a right mini-thoracotomy is still limited by the small operating field, the longer cardiopulmonary bypass time compared to the standard approach, and the need for a peripherical cannulation. Th e purpose of this study is to review our experience with isolated aortic valve replacement through a right minithoracotomy.
Methods: Between January 2010 and October 2012, 100 patients (mean age 70.1 ± 13.6 years) were scheduled for MIAVR. In the first 46 patients, the aortic cannulation and clamping were performed through a right mini-thoracotomy (6 cm max) with a percutaneous vacuum-assisted venous drainage through the groin. A total central arterial and venous cannulation was adopted in the following 54 patients. All patients received an aortic valve replacement with the same pericardial bioprosthesis implanted using three 2-0 prolene running sutures.
Results: Overall cardiopulmonary bypass and cross-clamp time were, respectively, 61.9 ± 17.1 minutes and 48.9 ± 15 minutes. Skin-to-skin time was 187.8 ± 41 minutes. Th e median prosthesis size was 25 mm. Median post-operative ventilation time was 17 hours, and mean intensive care and hospital stay were 2.7 days and 11.3 days, respectively. No deaths have been recorded.
Conclusions: Our data confirm that MIAVR achieved through a right mini-thoracotomy is a safe alternative for patients requiring isolated aortic valve replacement. Cardiopulmonary bypass, aortic cross-clamp, and skin-to-skin time were comparable to those operated with a standard full sternotomy approach at our department. The central cannulation can be easily performed without increasing the surgical time and avoiding groin incisions. The advantages of this technique include early mobilization and rehabilitation, an excellent aesthetic result, and lower risk of wound complications.

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