Rapid deployment aortic valve replacement through anterior right thoracotomy: Clinical outcomes and haemodynamic performance

Abstract

Background The ease of implantation of the rapid deployment (RD) and sutureless valves has contributed to the adoption of anterior right thoracotomy (ART) approach for aortic valve replacement (AVR). Aim of the study This study evaluates the safety and haemodynamic performance of minimally invasive AVR through ART using the RD valves. Methods This is a retrospective, single‐center review of a total of 50 consecutive patients who received RD‐AVR through ART. Results The median age of patients was 75 years (interquartile range [IQR]: 69‐80), and median Euroscore II was 5.1 (IQR: 2.4‐7.5). ART RD‐AVR was successfully performed in all cases with no conversion to sternotomy, paravalvular leaks or need for valve explantation. The mean size of the implanted valve was 23.2 ± 2.3 mm. In‐hospital mortality was 2%. The mean and maximum pressure gradients across the aortic prosthesis were 10 mm Hg (IQR: 9‐12) and 19 mm Hg (IQR: 16‐23). Conclusions Rapid deployment aortic valve replacement can be safely performed through anterior right thoracotomy wit excellent haemodynamic performance and low postoperative complications rate.

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

“…Furthermore, there were some concerns in mini‐AVR regarding the reported increased risk of cerebrovascular accidents 18 . Other attempts have been made to perform mini‐AVR with combination of central aortic and femoral venous cannulation 19,30 . Several studies analyzing mini‐AVR with the right minithoracotomy approach have identified retrograde perfusion as the only independent risk factor for stroke, suggesting that femoral cannulation is a feasible option for patients without peripheral vascular disease 18 .…”

“…18 Other attempts have been made to perform mini-AVR with combination of central aortic and femoral venous cannulation. 19,30 Several studies analyzing mini-AVR with the right minithoracotomy approach have identified retrograde perfusion as the only independent risk factor for stroke, suggesting that femoral cannulation is a feasible option for patients without peripheral vascular disease. 18 However, this was not observed in the study by Lamelas et al 30 Also, we have noticed that a loss of the right internal mammary artery was not of clinical significance in the current series.…”

“…There is a growing evidence in literature that in comparison with conventional AVR, mini‐AVR can reduce postoperative morbidity allowing less blood loss, less pain, faster recovery, and a shorter hospital stay with no difference in mortality 13–16 . In addition, two arterial perfusion strategies are currently utilized, such as peripheral femoral arterial cannulation, which is the most frequently used, and central aortic cannulation 7,17–19 . However, peripheral cannulation adds a wound in the groin with a risk of cerebrovascular accidents and groin‐related complications 17,18 …”

“…[13][14][15][16] In addition, two arterial perfusion strategies are currently utilized, such as peripheral femoral arterial cannulation, which is the most frequently used, and central aortic cannulation. 7,[17][18][19] However, peripheral cannulation adds a wound in the groin with a risk of cerebrovascular accidents and groinrelated complications. 17,18 Restricted operative field and increased XCT were one of the arguments for surgeons not performing the right minithoracotomy.…”

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

“…Operative setup for the right anterior minithoracotomy (RAMT) approach. (B) Exposure of the aortic valve through a RAMT Various studies have shown that RAMT AVR is associated with a low rate of postoperative complications and favorable midterm survival 19,23,24,[36][37][38][39][40][41][42][43][44][45][46]. Our center established a minimally invasive…”