Abstract
Minimally invasive aortic valve replacement has gained consent due to its good results in terms of minimized surgical trauma, faster rehabilitation, pain control and patient compliance. In our experience, we have tried to replicate the conventional and gold standard approach through a smaller incision. Sparing the right internal thoracic artery, avoiding rib fractures and performing total central cannulation is important to make this procedure minimally invasive from a biological point of view too. In addition, the total central cannulation is pivotal to simplify perfusion and drainage. Moreover, a complete step-by-step procedure optimization and-when possible-the use of sutureless prosthesis help to reduce the cross-clamping and perfusion times. After more than 1000 right anterior thoracotomy (RAT) aortic valve replacements, we have found tips and tricks to make our technique more effective.
Highlights
Invasive aortic valve replacement (AVR) via right anterior thoracotomy (RAT) (MiAVR-RAT) is a technique developed in the past few years
After more than 1000 right anterior thoracotomy (RAT) aortic valve replacements, we have found tips and tricks to make our technique more effective
We would enlighten the tight link between operative time and “biological” invasiveness: the longer the cardioplegic arrest and the cardiopulmonary bypass (CPB) time, the greater the biological cost the patient would pay[7]
Summary
= Aortic valve replacement = Cardiopulmonary bypass = Computed tomography = Elongated One-Piece Arterial Cannula = Intensive care unit = Polytetrafluoroethylene = Patient-prosthesis mismatch = Right anterior thoracotomy = Transcatheter aortic valve implantation
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