Minimally invasive aortic valve replacement (AVR) compared to standard AVR

Abstract

The limited superior median sternotomy provides good exposure to the left ventricular outflow tract, aortic valve, ascending aorta, and even to the mitral valve through the roof of the left atrium. Therefore it seems to be suitable for all kinds of aortic valve operations. Besides less pain, shorter skin incision, shorter respiratory support time and lower blood loss, it has more advantages as opening and closure of the sternum is faster; decreasing infection and disruption of the sternum, and finally decreasing the time required for hospitalization and recovery.

Early and late outcomes of 1000 minimally invasive aortic valve operations☆

“…Many studies have shown that it can be done safely with mortality and morbidity similar to conventional full sternotomy aortic valve surgery [3][4][5][6][7][8][9][10][11][12][13][14][15]. Several studies have also shown that the minimal access approach contributes to better surgical outcomes compared to a full sternotomy [3][4][5][14][15][16] although it is still controversial. We began minimal access approaches for aortic valve surgery in July 1996 and have demonstrated excellent early outcomes [2,3].…”

015 * Propensity Score Analysis of Outcomes Following Minimally Invasive Versus Conventional Aortic Valve Replacement

“…Although, retrospective studies (Liu, Sidiropoulos, & Konertz, 1999;Vanoverbeke et al, 2004) as well as prospective randomized studies (Aris et al, 1999;Bonacchi et al, 2002) Doll and colleagues reported a non-significant difference between MIAVR and CAVR in regard to the type of the prostheses used, but the rate of the implanted mechanical prostheses (55% and 52%, p=0.8) was higher in both groups than the implanted bioprostheses (45% and 47%, p=0.8 respectively) (Doll et al, 2002). Bakir and associates also found no significant differences in the type of the used prostheses between MIAVR and CAVR groups, but the rate of the implanted bioprostheses was higher in both groups (76.6% and 79.2%, p=0.75) than the rate of the implanted mechanical prostheses (23.3% and 20.8%, p=0.55) (Bakir et al, 2006).…”

“…A decrease of the length of stay is an important aspect of resource use, since ICU and hospital stay are the major determinants of the cost after cardiac surgery (Hamilton, Norris, Wensel, & Koshal, 1994). Several studies had also demonstrated reduced hospital stay and costs for minimal access AVR when compared with conventional AVR (Doll et al, 2002;Liu et al, 1999;Raja et al, 2013;Svensson & D'Agostino, 1998;Vanoverbeke et al, 2004).…”

Acesso minimamente invasivo para troca da valva aórtica: resultados operatórios imediatos comparativos com a técnica tradicional

“…These cases included intraoperative infarction requiring revascularization of the anterior interventricular branch, laceration of the right ventricle and myocardial dysfunction attributed to pericardial compression. Authors such as LIU et al [16] stated that the surgical exposure and access of the ascending aorta are better with accesses that do not totally dissect the anterior mediastinum, as the heart remains in a relatively anterior position. They emphasize also that miniincisions make opening and closing of the sternum easier and quicker.…”

“…Clearly, smaller incisions are cosmetically more acceptable for patients. The TYSZKA, AL ET AL -Minimally invasive aortic valve replacement: a comparison of results with the traditional technique smaller wounds reduce trauma and the potential for operative infection, blood loss and sternal dehiscence [16]. This approach preserves all the advantages of the median approach and still has the potential to correct other diseases, such as mitral valve operations, both by the left atrium roof or by the interatrial septum (Guiraudon's approach), as already described by many authors.…”