Eastern Cardiothoracic Surgical Society

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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.
METHODS:
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.
RESULTS:
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.
CONCLUSIONS:
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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