Aortic Valve replacement via Right Anterior miniThoracotomy and sutureless valve
Gabriele Tamagnini, Mauro Del Giglio.
Villa Torri Hospital, Bologna, Italy.
OBJECTIVE: We present our surgical AVR experience in this field, with RAT (Right Anterior miniThoracotomy access and sutureless valves. We believe the technique optimization and a minimal invasive approach are pivotal in making this procedure effective.
METHODS: We perform minimally invasive sAVR since 2010; we use suterless valve from July 2016.The procedure is made through a 6 to 8 cm long RAT at the third intercostal space without rib avulsion or ligation of the RIMA. As usual, we perform a complete central cannulation with normotermic systemic perfusion and blood-based cardioplegia. We optimized the implantation technique as a teamwork, making a simple step-by-step process.
RESULTS: in our experience the implanted prosthesis sizes were M (50%), L (34%), XL (12%), S (4%); mean CPB duration was 32,6 ± 8,2 minutes; aortic cross-clamping time 17,6 ± 3,7 minutes; median ventilation time 6,5 hrs; median ICU stay 2 days. Observed mean bleeding rate in the first 12 hours was 536 ± 150 ml, 46,5% patients needed blood transfusion (median number of bags: 1). PM implantation rate was 1,7%. The total in-hospital stay median duration was 7 days. Observed 30-day mortality rate was 1,7% (1pts), observed Morbidity/Mortality rate 5,88%. None of our patients had paravalvular aortic regurgitation more than mild at discharge.
CONCLUSIONS: Minimally invasive sAVR with suturless prostheses is an effective option for aortic valve replacement. Complete central cannulation, RAT approach and a thorough optimization of the implantation technique are the key points to carry out a fast and safe procedure.
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