Aortic Valve Surgery: Minimally Invasive Options

Ramlawi, Basel; Bedeir, Kareem; Lamelas, Joseph

doi:10.14797/mdcj-12-1-27

Cited by 19 publications

(17 citation statements)

References 54 publications

(46 reference statements)

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“…Some routinely transect the third costal cartilage 25. After sacrificing the right internal thoracic artery, a soft tissue retractor is inserted into the thoracotomy and direct aortic cannulation is performed using flexible cannulae.…”

Section: Surgical Techniques and Pitfallsmentioning

confidence: 99%

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Minimally invasive surgical aortic valve replacement

Jahangiri

Hussain

Akowuah

2019

Heart

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Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions as opposed to full sternotomy. It is performed using cardiopulmonary bypass with cardiac arrest. It benefits from potential advantages of a less invasive procedure. To date, over 14 000 MIAVR have been reported in the literature. Due to heterogeneity of the studies, different surgical techniques and mainly the non-randomised nature of these studies comparing MIAVR with conventional aortic valve replacement, it is difficult to draw definitive conclusions. The two main techniques of MIAVR are mini-sternotomy and right anterior mini-thoracotomy. Both techniques with other less common forms of MIAVR will be discussed in this review. The advantages, disadvantages and surgical pitfalls will be discussed. Some of the advantages include shorter intensive care and hospital stay, reduced perioperative blood loss, less pain, improved respiratory function and cosmesis. The possible disadvantage of longer bypass and cross-clamp times may be counter balanced by the recent sutureless and rapid deployment valves. Despite some of the benefits, MIAVR has not been adopted by a significant proportion of the surgeons possibly related to the learning curve and requirements for re-training. As MIAVR becomes more common, randomised trials comparing this technique with transcatheter aortic valve implantation is warranted. In addition, assessing quality of life including return to work and functional capacity is needed.

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Section: Surgical Techniques and Pitfallsmentioning

confidence: 99%

“…Both parasternal and transverse sternotomy incisions have been abandoned due to complications 25. One of the major limitations of the parasternal approach was the high incidence of lung herniation which often required a second procedure to repair the defect 27…”

Section: Surgical Techniques and Pitfallsmentioning

confidence: 99%

Minimally invasive surgical aortic valve replacement

Jahangiri

Hussain

Akowuah

2019

Heart

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“…As covered in a recent review, data from upper hemisternotomy and mini-thoracotomy aortic valve operations have consistently found a lower blood transfusion requirement and variability, a decreased incidence of atrial fibrillation, and lower length of ICU and hospital stay. 5 At the same time as the lower hemisternotomy was explored in Boston and elsewhere, the historical use of a right thoracotomy incision for intracardiac surgery inspired others to pursue the use of right minithoracotomy incisions with modified central or peripheral cannulation techniques for minimally invasive approach to MV repair. Port access platform (originally ''Heart Port'' access); minimally invasive MV surgery; and robot-assisted MV surgery are more advanced, organized variations on the right mini-thoracotomy approach.…”

Section: The Minimally Invasive Eramentioning

confidence: 99%

What's New in Mitral Valve Repair?

DiBardino

Farivar

2017

Journal of the Minneapolis Heart Institute Foundation

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Mitral valve repair is the standard of care for degenerative mitral valve pathology, as established by the median sternotomy approach. Equivalently excellent results can be achieved by a variety of more minimally invasive approaches depending on institutional experience and preferences. At the Minneapolis Heart Institutet, we have experience with and utilize all approaches to mitral valve repair for degenerative disease including full and hemisternotomy, right thoracotomy, mini-thoracotomy and heart port approaches. We believe that logistic, economic, and anticipated benefit constraints currently limit the application and the robotic technology. Leaflet maneuvers continue to be important in mitral valve repair, but recently we have revisited the concept of simplifying a ''complex'' repair in the setting of a subset of severe degenerative (Barlow's) disease by utilizing only an oversized mitral valve ring with excellent results. As suggested by others, in the appropriate setting of bileaflet prolapse resulting in central symmetric regurgitation, a simplified approach may be just as effective as longer, more complicated operations. 1. Degenerative MV disease can be repaired in the majority of cases with a durable long-term result and very low reoperative rate. Experienced centers can reproducibly expect repair rates of over 90% with a 1% failure rate/year. 2. The life expectancy curves for those that undergo repair approach those of the normal life expectancy curves for men and women, and in certain cases may be better than twins without the disease. 3. The repair techniques include a finite list of leaflet maneuvers and should always include the placement of a ring for annular fixation. The leaflet maneuvers include various resections, plications, commissure, and cleft closures; edge-toedge repairs; and artificial chord placement based upon the findings of the echo and the appearance of the degenerative pathology at the time of surgery. KEY WORDSGiven the evolution and success of these surgical tenets, the American College of Cardiology/American Heart Association guidelines have recommended MV surgery for symptomatic MR and minimally symptomatic MR in the presence of left ventricular dilation or dysfunction, and-at centers of excellence-can be considered for asymptomatic patients. Secondary to these recommendations, an estimated 40,000 MV operations take place in the US per year; given the low prevalence of rheumatic disease in the US, the majority of these patients are sent to surgery with MR and the majority of them are potential candidates for MV repair rather than replacement.

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“…However, obesity can also difficult to have a good view of the surgical field, needing full sternotomy in some cases [2] . Patients requiring other cardiac concomitant procedures cannot be performed through a MICS [25,26] . Minimally invasive cardiac surgery for AVR has significantly improved over past decades and it will be paradigm for the future of cardiac surgery, especially in terms of costs-benefits.…”

Section: Minimally Invasive Aortic Valve Replacement: Is It Now the Bmentioning

confidence: 99%

Minimally Invasive Aortic Valve Replacement: Is It Now the Best Surgical Approach?

Reyes

Calle

2016

Journal of Cardiology and Therapy

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Full sternotomy aortic valve replacement has been the gold standard for the treatment of severe aortic stenosis. Now transcatheter aortic valve implantation is becoming a new procedure that has shown its efficacy in a high risk population with aortic stenosis. Minimally invasive aortic valve replacement, using a 7-9 centimeters incision with an upper sternotomy tries to obtain the advantages and open surgical field and the less aggression of transcatheter procedures. We review the pros and cons of the minimally invasive aortic valve replacement updating the information obtained in the literature.

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Aortic Valve Surgery: Minimally Invasive Options

Cited by 19 publications

References 54 publications

Minimally invasive surgical aortic valve replacement

Minimally invasive surgical aortic valve replacement

What's New in Mitral Valve Repair?

Minimally Invasive Aortic Valve Replacement: Is It Now the Best Surgical Approach?

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