OC01 AORTIC VALVE REPLACEMENT THROUGH A RIGHT MINI-THORACOTOMY: MORE THAN 600 PATIENTS FOR A SINGLE CENTER EXPERIENCE

Abstract

Background and aim: Aortic valve replacement through a right mini-thoracotomy is a minimally invasive procedure developed during the last years. It is not frequently used because of a tiny operating field, limiting surgeon's view resulting in longer cardiopulmonary bypass and cross clamping times compared to the standard full sternotomy. Methods: We reviewed 604 patients (334 male 55% with median age of 75; range 16–93 years) who received an aortic valve replacement between January 2010 and April 2018 through a right mini-thoracotomy In the first 45 patients the aortic cannulation and clamping were performed through the right minithoracotomy while a vacuum assisted venous drainage was obtained percutaneously through the groin. A total central arterial and venous cannulation was than preferred. The maiority received an aortic valve replacement with a pericardial bioprothesis sutured using three 2–0 prolene running sutures. Results: Aortic replacement was performed through a 4 to 6 cm skin incision at the third intercostal space. 6 patients were a REDO cases. Overall median cardiopulmonary bypass and aortic cross clamping time was respectively 54 minutes (range 25–121) and 42 minutes (range 16–134). Median ventilation time and intensive care stay were 7 and 44 hours. Patients transfused were 42%. Hospital mortality was 1.4% (7/488). Conclusions: This single cenetr experience show that thanks to a standardized technique cardiopulmonary bypass and cross-clamping times comparable with the standard can be obtained and peripheral cannulation avoided. Advantages of this technique include early mobilization and rehabilitation, excellent aesthetic result and lower risk of wound complications.