The First 100 Cases of Two Innovations Combined: Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Mini-Thoracotomy Using a Novel Aortic Prosthesis

Abstract

Introduction: Aortic valve replacement (AVR) via right anterior mini-thoracotomy (RAMT) is less traumatic than via other surgical routes; using a novel aortic valve may confer long-term resistance against valve deterioration, and thus be useful in younger, more active patients. Here we aim to validate using the INSPIRIS RESILIA valve with minimally invasive RAMT. Methods: Between April 2017 and June 2019, 100 patients underwent video-assisted minimally invasive AVR by RAMT, using the INSPIRIS RESILIA aortic valve. Cannulation for cardiopulmonary bypass (CPB) was through femoral vessels. Clinical data were prospectively entered into our institutional database. Results: Cardiopulmonary bypass (CPB) and cross-clamping times were 79 ± 38 and 41 ± 17 min. Surgical access was successful in 100% of cases. There were no cases of intraoperative mortality, 30-day mortality, cerebrovascular events, rethoracotomy for bleeding, valve-related reoperation, right internal mammary artery injury, or conversion to sternotomy. Intensive care and hospital stays were 2 ± 1 and 6 ± 3 days, respectively. One patient had a pacemaker fitted. Postoperative dialysis was necessary in one patient. Trace to mild aortic valve regurgitation occurred in two patients. No structural valve deterioration (SVD) and paravalvular leak were seen. At 1-year follow-up mean effective orifice area (EOA) was 1.8 ± 0.1 cm 2 , peak gradient was 22.1 ± 3.1 mmHg, and mean gradient was 11.5 ± 2.3 mmHg. Conclusion:Our preliminary experience suggests that RAMT for AVR using the INSPIRIS RESILIA aortic valve is safe, effective, and reproducible. Larger studies are needed to evaluate the long-term efficacy and durability of this new valve.

Lessons learned from 10 years of experience with minimally invasive cardiac surgery

“…Elderly patients benefit even from the slightest advantages of endoscopic MICS by decreasing surgical trauma and perioperative pain, blood transfusions, hospital and intensive care unit (ICU) length of stay, ventilation time, wound infections, cost of hospitalization, and rehabilitation when compared to the CS. Moreover, for the young patient group, these techniques improve the cosmetic, quality of life, and patient satisfaction with an earlier return to normal activities ( 3 , 4 , 6 ). Even patients with difficult anatomical conditions, such as pectus excavatum or dextrocardia by situs inversus (DSI), are suitable for an endoscopic MICS when performed at experienced MICS centers.…”

µAVR: Endoscopic Microinvasive Aortic Valve Surgery With Automated Suturing Technology for Enhanced Patient Outcomes

“…The right anterior minithoracotomy approach has been demonstrated to provide less postoperative pain, shorter and easier recovery, and more rapid return to full function. 1,2 This approach should also reduce time spent in the operating room, intensive care unit, and hospital. However, many surgeons perceive less invasive cardiac surgery as having a steep learning curve and too many technical challenges, primarily due to limited remote working space and reduced direct visualization.…”

Mid-term clinical and echocardiographic results of the INSPIRIS RESILIA aortic valve: a retrospective comparison to the Magna Ease

“…Only a few (4) centres have shared their experience [ 14–17 ]. The largest series regroups 100 patients with a 1-year echocardiographic FU [ 15 ]. However, most patients were aged <60 years, and 17% received a 19- or 21-mm valve.…”