Minimally invasive aortic valve surgery

Abstract

Since their introduction, it has been demonstrated that minimally invasive aortic valve replacement (MIAVR) approaches are safe and effective for the treatment of aortic valve diseases. To date, the main advantage of these approaches is represented by the reduced surgical trauma, with a subsequent reduced complication rate and faster recovery. This makes such approaches an appealing choice also for frail patients [obese, aged, chronic obstructive pulmonary disease (COPD)]. The standardization of the minimally invasive techniques, together with the implementation of preoperative workup and anesthesiological intraand post-operative care, led to an amelioration of surgical results and reduction of surgical times. Moreover, the improvement of surgical technology and the introduction of new devices such as sutureless and rapid deployment (SURD) valves, has helped the achievement of comparable results to traditional surgery. However, transcatheter technologies are nowadays more and more important in the treatment of aortic valve disease, also in low risk patients. For this reason surgeons should put new efforts for further reducing the surgical trauma in the future, even taking inspiration from other disciplines. In this review, we aim to present a review of literature evidences regarding minimally invasive treatment of aortic diseases, also reflecting our personal experience with MIAVR techniques. This review could represent a tool for a well-structured patient assessment and preoperative planning, in order to safely carrying out an MIAVR procedure with satisfactory outcomes.

Minimal Invasive Aortic Valve Replacement by Upper Ministernotomy Approach in Comparison to The Conventional Full Median Sternotomy Approach

“…In addition, the presence or absence of sternal fractures may play an important role in early postoperative pain levels. Additionally, we have drawback in our study that actually pain management was not standardized for all patients (12) .…”

Totally endoscopic aortic valve replacement: Techniques and early results

“…In 1996, Konertz et al first reported the AVR through the small incision of the upper sternum ( 8 ), many cardiac surgeons tried one after another, and the shape of the sternum incision gradually evolved from the “T” and “V” shape to the classic “J” shape or reverse. The “L” shape has become the most used minimally invasive AVR surgery ( 9 ). However, although these surgeries avoid full incision of the sternum, they still destroy the stability of the sternum.…”

The 10 Commandments of Perceval Implantation

“…Minimally Invasive Aortic Valve Replacement [29][30][31][32][33] The Perceval facilitates aortic valve replacement through smaller incisions by eliminating the need for placing and tying sutures with limited exposure. Unlike transcatheter approaches, the Perceval allows direct visualization of the valve, appropriate decalcification of the annulus, and controlled direct deployment.…”