Abstract
ObjectivesA right minithoracotomy approach with a sternal sparing technique is a minimally invasive option for surgeons performing aortic root surgery. This report presents our initial clinical results of the right minithoracotomy Bentall procedure.MethodsClinical data of 15 patients were retrospectively analyzed who underwent the minimally invasive Bentall procedure through the right anterior thoracotomy via the second intercostal incision without any costochondral cartilage invasion at our institution between October, 2019 and June, 2021. The operative time, length of intensive care unit stay and postoperative hospital stay, perioperative outcomes, and follow-up results were analyzed.ResultsThe median aortic cross-clamping time was 95.0 (85.5–98.8) min. Three (21.4%) patients received blood transfusion. The median drainage volume in the first 24 h was 200.0 ml, with no redo for bleeding. The median duration of mechanical ventilation was 12.5 (11.0–25.0) h, and median length of intensive care unit stay was 1.5 (1.0–3.0) day. All patients discharged 5.8 ± 1.2 days following surgery, with no dead patients found. At 6 months following surgery, all patients survived with an improved New York Heart Association (NYHA) functional class.ConclusionThe right minithoracotomy Bentall procedure may be performed safely with low morbidity and mortality. This approach should be considered as an option in carefully selected patients requiring aortic root replacement.
Highlights
As technology advances and surgeon experience increases, increasing patients undergo miniinvasive cardiac surgery, and the range of minimally invasive cardiac surgery continues to broaden
The success of the right minithoracotomy aortic valve replacement (AVR) may translate into favorable outcomes in selected patients undergoing the right minithoracotomy approach for aortic root surgery
All included patients suffered from aortic sinus pathology with concomitant aortic valve disease without arch lesions documented by echocardiography
Summary
As technology advances and surgeon experience increases, increasing patients undergo miniinvasive cardiac surgery, and the range of minimally invasive cardiac surgery continues to broaden. The most common surgical approach to aortic root replacement is a full median sternotomy [1, 2]. A right anterior minithoracotomy approach for minimally invasive aortic valve replacement (AVR) is a well-established surgical procedure. It has several advantages over AVR through sternotomy in terms of decreased blood loss, shortened length of hospital stay, decreased pain, early recovery of pulmonary function, improved cosmesis, and a rapid return to daily activities [6, 7]. The success of the right minithoracotomy AVR may translate into favorable outcomes in selected patients undergoing the right minithoracotomy approach for aortic root surgery. A right minithoracotomy Bentall procedure which includes the utilization of video guidance and automated suturing technology has been described [8]
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