Our experience with surgical minimally invasive aortic valve replacement

Abstract

BackgroundIn the context of the development of modern cardiac valve interventional methods (TAVI, TMVI, MitraClip), miniinvasivity in cardiac surgery is becoming increasingly important. An alternative approach to complete sternotomy in isolated aortic valve replacement (AVR) is access from anterior thoracotomy or upper ministernotomy. In CKTCH Brno, is performed an isolated aortic valve replacement (AVR) from the upper hemisternotomy (UHS) from 2013 onwards. MethodsBetween 2013 and 2016, isolated AVR was perfomed in our institution 666 patients. Full median sternotomy approach was used in 565 patients, minimally invasive approach (UHS) in 101 patients. In the ministernotomy group, classical biological or mechanical prosthesis was implanted in 55 patients; in 46 patients we used rapid deployment (sutureless) bioprosthesis Sorin Perceval S. In our study we compare the results of full sternotomy a hemisternotomy approach and also describe our surgical technique of minimally invasive aortic valve replacement. ResultsWe registered gradual increase in minimally invasive AVR between 2013 and 2016 (9 patients in 2013, 59 patients in 2016). The combined hospitalization and 30-day mortality was 0.53% (3 patients) in the full sternotomy group and 0.99% (1 patient) in the ministernotomy group. In the most risky patients, we indicated ministernotomy with implantation of rapid deployment bioprosthesis (Euroscore II. 3,0 vs. 1,6 in the group of patients with full sternotomy AVR). As published, we confirmed longer aortic cross clamp time (AoX) and lenght of extracorporal circulation (ECC) in the patients with ministernotomy and implantation of sutured aortic prosthesis in comparison with full sternotomy AVR. Conversely, shorter AoX time and ECC time was observed in patients with rapid deployment prosthesis implantation from ministernotomy. We also recorded smaller postoperative blood loss in patients with ministernotomy apporach. The other monitored parameter were comparable. ConclusionIn this study we describe our technique and results of minimally invasive aortic valve replacement in our institution. Based on our results, we evaluate this technique as safe and well reproducible.