Step-by-Step Minimally Invasive Aortic Valve Replacement: the RAT Approach.

Alina Zubarevich,Arjang Ruhparwar,Arian Arjomani Rad,Robert Vardanyan,Daniel Wendt,Konstantin Zhigalov,Bastian Schmack,Alexander Weymann

doi:10.21470/1678-9741-2020-0393

Abstract

In the growing era of transcatheter aortic valve implantation, it is crucial to develop minimally invasive surgical techniques. These methods enable easier recovery from surgical trauma, especially in elderly and frail patients. Minimally invasive aortic valve replacement (MIAVR) is frequently performed via upper hemisternotomy. We describe MIAVR via right anterior thoracotomy, which is associated with less trauma, rapid mobilization, lower blood transfusion rates, and lower risk of postoperative wound infections. As minimally invasive procedures tend to take longer operative times, we suggest using rapid-deployment valve prostheses to overcome this limitation. This description focuses on the technical aspects and preoperative assessment.

Highlights

In the growing era of transcatheter aortic valve implantation, it is crucial to develop minimally invasive surgical techniques
In the growing era of transcatheter aortic valve implantation (TAVI), surgical procedures are being challenged by faster patients’ mobilization, shorter intensive care unit (ICU) and in-hospital length of stay, and less surgical trauma offered by TAVI
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Summary

Introduction

In the growing era of transcatheter aortic valve implantation, it is crucial to develop minimally invasive surgical techniques. These methods enable easier recovery from surgical trauma, especially in elderly and frail patients. We describe MIAVR via right anterior thoracotomy, which is associated with less trauma, rapid mobilization, lower blood transfusion rates, and lower risk of postoperative wound infections. As minimally invasive procedures tend to take longer operative times, we suggest using rapid-deployment valve prostheses to overcome this limitation. This description focuses on the technical aspects and preoperative assessment. A chest computer tomography (CT)-scan was only performed if the X-ray showed any pathologies or anatomical abnormalities to plan the incision

Discussion

Conclusion