Totally endoscopic aortic valve replacement with concomitant trans-aortic mitral valve repair for mitral regurgitation

Antonios Pitsis,Harisios Boudoulas,Konstantinos Dean Boudoulas,Nikolaos Tsotsolis

doi:10.1186/s13019-021-01694-6

Antonios Pitsis, Harisios Boudoulas + Show 2 more

Open Access

https://doi.org/10.1186/s13019-021-01694-6

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Abstract

BackgroundMinimally invasive aortic valve procedures through a hemi-sternotomy or a right anterior mini-thoracotomy have gained popularity over the last several years. Totally endoscopic aortic valve replacement (TEAVR) is an innovative and a less invasive (incision-wise) surgical aortic valve replacement technique. The operative steps of TEAVR have been reported previously from our group. Mitral regurgitation (MR) frequently accompanies aortic valve disease that at times may also require repair. Totally endoscopic surgery in such cases has not been tested.Presentation of the techniqueWe present a surgical technique for a totally endoscopic approach to aortic valve replacement and concomitant mitral valve repair for primary and secondary MR. An aortotomy incision was used avoiding an atriotomy, which results in an increase in cross-clamp (XC) and cardiopulmonary bypass (CPB) times that could be associated with higher mortality and morbidity. Neochords (artificial chordae tendineae) were used for primary MR and an edge-to-edge approach for secondary MR.ConclusionTEAVR and concomitant mitral valve repair can be performed successfully with reasonable XC and CPB times with excellent short-term results.

Highlights

While endoscopic mitral and tricuspid valve procedures have become a first line treatment in many centers globally, this is not the case for the aortic valve
The operative steps of totally endoscopic aortic valve replacement (TEAVR) that has been routinely used at Thessaloniki Heart Institute, Thessaloniki, Greece, are described; more than 200 cases have been performed over a 2 year period7 [1]
Totally endoscopic aortic valve replacement (TEAVR) is a less invasive approach associated with shorter intensive care time and hospital length-of-stay. This method allows patients to return to work sooner compared to traditional surgery; it is associated with prolonged crossclamp (XC) and cardiopulmonary bypass (CPB) times, during the learning curve of this approach, albeit steep [1]