Consensus statement on aortic valve replacement via an anterior right minithoracotomy in the UK healthcare setting

Abstract

The wide uptake of anterior right thoracotomy (ART) as an approach for aortic valve replacement (AVR) has been limited despite initial reports of its use in 1993. Compared with median sternotomy, and even ministernotomy, ART is considered to be less traumatic to the chest wall and to help facilitate quicker patient recovery. In this statement, a consensus agreement is outlined that describes the potential benefits of the ART AVR. The technical considerations that require specific attention are described and the initiation of an ART programme at a UK centre is recommended through simulation and/or use of specialist instruments in conventional cases. The use of soft tissue retractors, peripheral cannulation, modified aortic clamping and the use of intraoperative adjuncts, such as sutureless valves and/or automated knot fasteners, are important to consider in order to circumvent the challenges of minimal the altered exposure via an ART.A coordinated team-based approach that encourages ownership of the programme by team members is critical. A designated proctor/mentor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider.

Minimal Access Aortic Valve Surgery

“…The authors of a recent consensus statement [47] acknowledged the increased tech- The authors of a recent consensus statement [47] acknowledged the increased technical challenge of a right anterior mini-thoracotomy approach. Additional equipment, such as thoracosopes, long-handled instruments, and soft tissue retractors, require specific training.…”

“…Use of scopes for lighting and/or transmitted video images may, however, limit access for instruments in some cases. This limitation can in part be mitigated using other adjuncts, such as automatic suture placement or knotting devices [47].…”