M. Glauber, D. S. Gilmanov, A. Miceli, P. A. Farneti, M. Ferrarini, M. Murzi, F. Chiaramonti, M. Solinas
2014 Interactive Cardiovascular and Thoracic Surgery  
Objectives: 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 mini-thoracotomy (RAMT) for AVR and compared the data to the Society of Thoracic Surgeons (STS) database. Methods: Between August 2004 and March 2014, 484 patients (males 271 (56%), mean age 70.6 ± 12 years) underwent isolated AVR through RAMT. Eight (1.7%) patients had previous heart
more » ... previous heart surgery. Mean NYHA functional class was 2.3; 136 (28%) patients were in NYHA III-IV advanced congestive heart failure. Forty-four (9%) patients had left ventricle ejection fraction (EF) <50%. In 42 (9%) patients combined valve lesion and in 77 (16%) pure aortic regurgitation were diagnosed preoperatively. Mean logistic EuroSCORE I was 7.8. Results: In 233 (48%) patients sutureless or rapidly implantable biological prosthesis were used. Eighty-two (17%) patients had small aortic annulus (21 mm or less). Operative times averaged 81 min of cross-clamping time [interquartile range (IR) 57-97 min] and 116 min of CPB time (IR 89-136 min) and were significantly lower (P = 0.0000 for both) with sutureless prostheses compared with sutured ones. In 9 (1.9%) cases conversion to full sternotomy was necessary. Hospital length of stay averaged 6.2 days (IR 6-7 days). Overall in-hospital mortality was 4 (0.8%). At 27 months median follow-up (IR 15-58 months; cumulated follow-up 1231 patient-years), 95.3% survival is observed. Complication n (%) Revision for bleeding 23 (4.8%) Myocardial infarction 3 (0.6%) Wound dehiscence or infection 2 (0.4%) Stroke 6 (1.2%) Transient ischaemic attack 5 (1.0%) Respiratory distress and/or need for prolonged mechanical ventilation 4 (0.8%) Acute renal failure recovered with continuous renal replacement therapy 1 (0.2%) Permanent pacemaker implant 7 (1.4%) New onset atrial fibrillation 91 (19%) Acute postoperative aortic dissection 1 (0.2%) Conclusion: Excellent outcomes can be achieved with minimally invasive aortic valve replacement through RAMT. Sutureless prostheses facilitate minimally invasive AVR and are associated with reduced operative times. Interactive CardioVascular and Thoracic Surgery
doi:10.1093/icvts/ivu276.14 fatcat:jz6j4stipzbqrj37fm2z2kcxbi