Minimally Invasive Aortic Valve Replacement Via Right Anterior Mini-Thoracotomy: Propensity Matched Initial Experience

Seitz, Michael; Goldblatt, Joshua; Paul, Eldho; Marcus, Thomas; Larobina, Marco; Yap, Cheng‐Hon

doi:10.1016/j.hlc.2017.11.012

Cited by 15 publications

(27 citation statements)

References 27 publications

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“…[4][5][6][7][8] Besides the general advantage of MIA, RAMT enables a smaller incision with avoidance of sternotomy, rib resection, or joint dislocation, leading to less invasiveness compared with other MIAs. [5][6][7][8][9][10][11][12] Several studies demonstrated that RAMT was associated with less surgical trauma, a lower incidence of blood transfusion, AF, postoperative stroke, and wound infection, as well as shorter ventilation times and hospital stays compared with CS AVR. [5][6][7][8][9][10][11][12] Recent studies have also reported the superiority of RAMT compared with other MIAs.…”

Section: Discussionmentioning

confidence: 99%

Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Minithoracotomy for All Comers With Aortic Valve Disease

Bakhtiary¹,

Ahmad²,

Amer³

et al. 2020

Innovations�(Phila)

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Objective Right anterior minithoracotomy is a promising technique for aortic valve replacement and has shown excellent results in terms of mortality and morbidity. Against this background, we analyzed our institutional experience in this technique during the last 3 years. Methods Between April 2017 and March 2019, 513 consecutive all comers with aortic valve disease underwent video-assisted minimally invasive aortic valve replacement through a 3-cm skin incision as right anterior minithoracotomy at our institution. A camera and automatic fastener technology were used for the valve implantation in all patients. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time accounted for 68 ± 24 min and the myocardial ischemic time 38 ± 12 minutes. Thirty-day mortality and overall mortality was 0.4% (2 patients) and 1.4% (7 patients), respectively. Postoperative cerebrovascular events were noted in 8 patients (1.5%). Intensive care stay and hospital stay were 2 ± 2 and 9 ± 7 days, respectively. Pacemaker implantation, injury of the right internal mammary artery, and conversion to full sternotomy were noted in 7 patients (1.4%), 3 patients (0.6%), and 1 patient (0.2%), respectively. Paravalvular leak need to intervention was noted in 2 patients (0.4%). Rethoracotomy rate was 2% (11 patients). Transient postoperative dialysis was necessary for 14 patients (3%). Conclusions Video-assisted minimally invasive aortic valve replacement through the right anterior minithoracotomy is a safe approach and yields excellent outcomes in high-volume centers. The use of a camera and automatic fastener technology facilitates this procedure.

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Section: Discussionmentioning

confidence: 99%

Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Minithoracotomy for All Comers With Aortic Valve Disease

Bakhtiary¹,

Ahmad²,

Amer³

et al. 2020

Innovations�(Phila)

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“…7 AVR remains the best long-term treatment for severe aortic stenosis and represents a major proportion of adult cardiac surgical procedures worldwide. 8 Median sternotomy is still the most utilized approach for surgical AVR. Despite its physiologic burden, it is a very effective operation associated with low mortality and morbidity, with improved symptoms and quality of life, as shown in the German registry.…”

Section: Discussionmentioning

confidence: 99%

Is it safe to move away from a full sternotomy for aortic valve replacement?

Kenawy

Abdelbar

Tennyson

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Minimally invasive surgical approaches have gained popularity among patients and surgeons. The aim of this project was to assess the safety of initiating aortic valve replacement via an anterior right thoracotomy program. Methods Between May 2015 and May 2019, data of all isolated primary aortic valve replacements were extracted retrospectively from our prospectively collected database and categorized into conventional median sternotomy, hemisternotomy, and anterior right thoracotomy cases. In total, 661 patients underwent isolated primary aortic valve replacement, of whom 429 (65%) had a median sternotomy, 126 (19%) had a hemisternotomy, and 106 (16%) had an anterior right thoracotomy. Preoperative characteristics were similar in each of the three groups. Statistical testing of the surgical groups was undertaken using the chi-square test for categorical variables and one-way analysis of variance with Tukey post-hoc pairwise tests (where appropriate) for continuous variables, to identify differences between pairs of data. Results Cardiopulmonary bypass and crossclamp times were significantly longer in the anterior right thoracotomy group compared to the hemisternotomy and median sternotomy groups ( p < 0.001). Blood loss was significantly less and hospital stay significantly shorter in the hemisternotomy group compared to median sternotomy group but not the anterior right thoracotomy group. Mortality, stroke, renal, gastrointestinal and respiratory complications showed no statistical differences. Conclusion Surgical aortic valve replacement had a very low mortality and morbidity in our experience, and it is safe to start a minimal access program for aortic valve replacement.

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“…A possible explanation for low incidence of new onset of atrial fibrillation was that limited heart manipulation and trauma, particularly in cases of minimally invasive surgery via right mini-thoracotomy, was associated with a reduction in the incidence of postoperative atrial fibrillation. 12,24) However, the relative benefit of minimally invasive valve surgery on postoperative atrial fibrillation remains debated in the literature. Some studies have re-ported a lower rate of postoperative atrial fibrillation with the use of minimally invasive surgery when compared to full median sternotomy with an absolute reduction of between 28% and 50%.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have suggested that minimally invasive valve surgery via right mini-thoracotomy is associated with a higher incidence of postoperative cerebrovascular events. 12,28) The reason may be that high atherosclerotic burden in the aortic arch and descending aorta may play a crucial role in the incidence of postoperative cerebrovascular accident when using retrograde perfusion, especially in elderly patients. By contrast, this study reported a similar incidence of stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Also, early studies showing difficulties in air RIGHT MINI-THORACOTOMY MULTI-VALVE SURGERY removal, inadequate mediastinal and pleural drainage, increased risk of para-valvular leak and higher reoperation rates. 11,12) Nevertheless, continuous advances in refining surgical techniques and advances in peri-operative management have led to efficiency and safety that have been at least equivalent to conventional surgery in their high volume, specialized centers. 13) With the recent breakthrough of percutaneous valve interventions, the role of minimally invasive surgery is now more than ever prompted to expand in the practice of daily cardiac valve surgery.…”

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confidence: 99%

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Combined Mitral and Aortic Valve Procedure via Right Mini-Thoracotomy versus Full Median Sternotomy

et al. 2019

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Data involving combined mitral and aortic valve procedure via the right mini-thoracotomy approach are very limited. This single-center propensity-matching study aimed to evaluate early clinical outcomes of patients who underwent combined mitral and aortic valve procedure via right mini-thoracotomy versus full median sternotomy.From January 2013 to December 2016, 926 eligible patients in our center were identified for this study. After propensity score-matching, 91 pairs of patients were entered into a RT group (right mini-thoracotomy surgery) or a FS group (full median sternotomy surgery). In-hospital and follow-up clinical outcomes were investigated and analyzed.Patients in the RT group received similar surgical mortality as patients in the FS group (1.1% versus 2.2%, P > 0.05). Patients in the RT group as compared with the FS group were less likely to receive postoperative new onset of atrial fibrillation and red cell transfusion (11.0% versus 25.3%, P = 0.012; 17.6% versus 37.4%, P = 0.003, respectively), but they shared similar incidences of other major postoperative morbidity. Patients in the RT group as compared with the FS group experienced 6-minute longer aortic cross-clamping times and 9minute longer cardiopulmonary bypass times, but received shorter intensive care unit stay and postoperative hospitalization time. No repeat valve operation, peri-prosthetic leak, or moderate or severe mitral valve regurgitation following valvuloplasty were observed in either group before discharge and also within one year of surgery.In primary, isolated, combined mitral and aortic valve procedure, a right mini-thoracotomy approach may be utilized with accepted early clinical outcomes, and may be considered as a feasible alternative to the approach of full median sternotomy.(Int Heart J 2019; 60: 336-344)

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Minimally Invasive Aortic Valve Replacement Via Right Anterior Mini-Thoracotomy: Propensity Matched Initial Experience

Cited by 15 publications

References 27 publications

Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Minithoracotomy for All Comers With Aortic Valve Disease

Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Minithoracotomy for All Comers With Aortic Valve Disease

Is it safe to move away from a full sternotomy for aortic valve replacement?

Combined Mitral and Aortic Valve Procedure via Right Mini-Thoracotomy versus Full Median Sternotomy

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