Minimally invasive aortic valve replacement with sutureless bioprosthesis through right minithoracotomy with completely central cannulation—Early results in 203 patients

Abstract

Objectives: Minimally invasive aortic valve replacement (mini-AVR) might improve clinical outcomes, particularly in high-risk and elderly patients. Sutureless/rapid deployment bioprosthesis can offer advantage of decreasing the cross-clamp time (XCT) and easing the procedure. Our aim was to evaluate the safety and perioperative outcomes of mini-AVR using sutureless bioprothesis via the right minithoracotomy approach with our modified technique of central cannulation. Methods: We performed a single-center retrospective analysis of 203 patients consecutively undergoing isolated AVR between March 2016 and June 2018 with the right minithoracotomy approach and our modified technique of central cannulation. Aortic valve diseases were stenosis (89.9%), regurgitation (1.6%), and mixed valve disease (8.5%). Patients with concomitant procedures were excluded. Primary endpoints were 30-day and 4-month mortality. Results: Mean age was 76 ± 6.2 years, 63 (31%) patients were 80 years or older. Cardiopulmonary bypass and XCT were 60.5 (39-153) and 35 (24-76) min, respectively. Thirty-day and 4-month mortality were 1% (two patients). We have observed minor paravalvular leak (PVL) which occurred in seven patients (3.4%), and no moderate/severe PVL was found perioperatively. One patient developed moderate/severe PVL during the 4-month follow-up. There was no structural valve degeneration. Two (1%) patients needed conversion to full sternotomy, and two (1%) patients to ministernotomy. Conclusions: Mini-AVR via the right minithoracotomy approach with central cannulation is an effective and safe procedure and demonstrates excellent early clinical outcomes. This approach can be particularly valuable in higher risk and elderly patients.

Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center

“…It is important to highlight the impact of rapid deployment and sutureless valves in facilitating RAMT AVR. Many groups and recent studies have found these valves to be especially useful for the RAMT approach, where they have resulted in comparable durability, shorter intraoperative times and better hemodynamics, while PPM insertion rate has varied based on the center 47–49 . As seen in our cohort, although conventional bioprosthetic and mechanical valves can be implanted via a RAMT incision, 95% of cases were performed by using a rapid deployment of sutureless valve.…”

“…Many groups and recent studies have found these valves to be especially useful for the RAMT approach, where they have resulted in comparable durability, shorter intraoperative times and better hemodynamics, while PPM insertion rate has varied based on the center. [47][48][49] As seen in our cohort, although conventional bioprosthetic and mechanical valves can be implanted via a RAMT incision, 95% of cases were performed by using a rapid deployment of sutureless valve. Finally, there were no conversions to sternotomy, no cases of limb ischemia or vascular complications, and no incidence of infective endocarditis or valve thrombosis.…”

Challenges in sutureless aortic valve implantation with minimal invasive technique

“…When the topic is minimally invasive, sutureless aortic valve replacement, we are highly interested, as all cardiovascular surgeons would. We have read with interest the article entitled: "Minimally invasive aortic valve replacement with sutureless bioprosthesis through right minithoracotomy with completely central cannulation-Early results in 203 patients" by Sef et al 1 For sutureless aortic valve implantation; the higher transverse aortotomy is required to be located approximately 0.5 cm above sinotubular junction or 3.5 cm above the aortic annulus. 2,3 The level of transverse aortotomy to be at least 2.5 cm above the sinotubular junction is quite high.…”

Current trends in minimally invasive valve-sparing aortic root replacement -- best available evidence

“…[9][10][11][12][13][14][15][16] Since the first report of minimally invasive aortic valve replacement (AVR) in 1993, minimally invasive access has been associated with comparable operative mortality, less bleeding and reduced intensive care and hospital stay when compared to the conventional sternotomy. 11,12,[17][18][19][20] Furthermore, faster recovery, less pain and better cosmesis have been reported in several clinical studies. [21][22][23] In this article, we have reviewed all the available literature on the topic of valve-sparing aortic root replacement (David procedure) via minimally invasive approach through upper hemisternotomy in an attempt to assess current trends and to recognize potential advantages of this technique.…”