Rapid Implantation and Right Anterior Minithoracotomy approach for surgical AVR
Gabriele Tamagnini, Diego Magnano, Enrico Ramoni, Mauro Del Giglio.
Villa Torri Hospital, Bologna, Italy.
OBJECTIVE: We present our surgical AVR experience in this field, with RAT access and sutureless valves. We believe the technique optimization and a minimal invasive approach are pivotal in making this procedure effective.
Retrospectively, from July 2016 to May 2018, we collected 60 consecutive elderly patients (≥80 y.o.), undergoing isolated sAVR for tricuspid severe aortic stenosis. Minimally invasive sAVR was performed through a small RAT at the third intercostal space without rib avulsion or ligation of the RIMA. we perform a complete central cannulation with blood-based cardioplegia.
All procedure went successfully. Complete central cannulation, RAT approach and sutureless prostheses have been used in all cases. Population: male 37,5%; mean age of 83,5 ± 2,2 yrs; mean STS Risk Score of Mortality 3,61% ± 1,23% and of Morbidity/Mortality 19,66% ± 4,58%. implanted prostheses were M (32), L (20), XL (5), S (3); 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. 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.
Minimally invasive sAVR with suturless prostheses is an effective option for aortic valve replacement in elderly patients. 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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