Surgery without Scars: Right Lateral Access for Minimally Invasive Aortic Valve Replacement

AbstractAs part of an institutionally driven holistic concept, named the “360-degree approach,” all established surgical access routes —full sternotomy, partial upper sternotomy, and right anterolateral thoracotomy using the second interspace—are supported. The surgical toolbox now is completed by adding a further approach: through a 5- to7-cm skin incision in the right anterior axillary line, the third interspace is used for a minimally invasive aortic valve surgery providing striking exposition of the aortic valve and resulting in superior cosmetics with nearly no visible scars. The choice for the one or other method is institutionally driven and based on risk profiles, as well as anatomical and physiognomic considerations.

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Simple Technique for Central Venous Cannulation with Cannula-Free Wound in Minimally Invasive Aortic Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520925549 ◽

2020 ◽

Vol 15 (4) ◽

pp. 369-371

Author(s):

Vasily I. Kaleda ◽

Alexander P. Nissen ◽

Anatoly V. Molochkov ◽

Ivan A. Alekseev ◽

Sergey Yu. Boldyrev ◽

...

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Aortic Surgery ◽

Skin Incision ◽

Valve Surgery ◽

Right Atrial ◽

Venous Cannulation ◽

Aortic Valve Surgery ◽

Central Venous Cannulation ◽

Central Venous

There are several approaches to venous cannulation in minimally invasive aortic valve surgery. Frequently used options include central dual-stage right atrial cannulation, or peripheral femoral venous cannulation. During minimally invasive aortic surgery via an upper hemisternotomy, central venous cannulas may obstruct the surgeon’s visualization of the aortic valve and root, or require extension of the skin incision, while femoral venous cannulation requires an additional incision, time and resources. Here we describe a technique for central venous cannulation during minimally invasive aortic surgery, utilizing a novel device, to facilitate simple, convenient, and expedient central cannulation with a cannula-free surgical working space.

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Key-Lock Type Mini-Sternotomy: An Alternative Approach for Adult Cardiac Operations

The Heart Surgery Forum ◽

10.1532/hsf98.20121096 ◽

2015 ◽

Vol 16 (2) ◽

pp. 83 ◽

Cited By ~ 1

Author(s):

Mert Dumantepe ◽

Arif Tarhan ◽

Azmi Ozler

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Septal Defect ◽

Skin Incision ◽

Alternative Technique ◽

Alternative Approach ◽

Defect Repair ◽

The Right ◽

Cardiac Operations

An alternative technique for minimally invasive aortic valve replacement and atrial septal defect repair is described. After a 5-cm skin incision, a key-lock type sternotomy is made. Excellent exposure of the right atrium and aortic valve was achieved. The configuration of the mini-sternotomy (or the lock) limits the movement of the sternal surfaces (or the key) on the lateral and craniocaudal directions.

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Minimally invasive permanent pacemaker implantation immediately after birth: from delivery room to heart surgery

Cardiology in the Young ◽

10.1017/s1047951121002808 ◽

2021 ◽

pp. 1-3

Author(s):

Mehmet Taşar ◽

Nur Dikmen Yaman ◽

Burcu Arıcı ◽

Ömer Nuri Aksoy ◽

Huseyin Dursin ◽

...

Keyword(s):

Minimally Invasive ◽

Atrioventricular Block ◽

Heart Surgery ◽

Pacemaker Implantation ◽

Skin Incision ◽

Permanent Pacemaker ◽

Invasive Technique ◽

Permanent Pacemaker Implantation ◽

Congenital Atrioventricular Block ◽

The Right

Abstract Introduction: Congenital atrioventricular block is diagnosed in uterine life, at birth, or early in life. Atrioventricular blocks can be life threatening immediately at birth so urgent pacemaker implantation techniques are requested. Reasons can be cardiac or non-cardiac, but regardless of the reason, operations are challenging. We aimed to present technical procedure and operative results of pacemaker implantation in neonates. Materials and methods: Between June 2014 and February 2021, 10 neonates who had congenital atrioventricular block underwent surgical operation to implant permanent epicardial pacemaker by using minimally invasive technique. Six of the patients were female and four of them were male. Mean age was 4.3 days (0–11), while three of them were operated on the day of birth. Mean weight was 2533 g (1200–3300). Results: Operations were achieved through subxiphoidal minimally skin incision. Epicardial 25 mm length dual leads were implanted on right ventricular surface and generators were fixed on the right (seven patients) or left (three patients) diaphragmatic surface by incising pleura. There were no complication, morbidity, and mortality related to surgery. Conclusion: Few studies have characterised the surgical outcomes following epicardial permanent pacemaker implantation in neonates. The surgical approach is attractive and compelling among professionals so we aimed to present the techniques and results in patients who required permanent pacemaker implantation in the first month of life.

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Introduction: minimally invasive aortic valve surgery supplement

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezx481 ◽

2018 ◽

Vol 53 (suppl_2) ◽

pp. ii1-ii2

Author(s):

Michael A Borger

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Valve Surgery ◽

Aortic Valve Surgery

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One incision, two cannulations for minimally invasive aortic valve surgery

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.12.170 ◽

2015 ◽

Vol 182 ◽

pp. 97 ◽

Cited By ~ 1

Author(s):

Shuyang Lu ◽

Lai Wei ◽

Xiaoning Sun ◽

Chunsheng Wang

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Valve Surgery ◽

Aortic Valve Surgery

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Abstract 12048: Minimally Invasive Access for Aortic Valve Surgery in Octogenarians: Is it Still Justified in the Days of TAVI ?

Circulation ◽

10.1161/circ.132.suppl_3.12048 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Udo Boeken ◽

Sudharson Rajah ◽

Jan Philipp Minol ◽

Payam Akhyari ◽

Artur Lichtenberg

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Hospital Stay ◽

Surgical Techniques ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Partial Sternotomy ◽

Number Of Patients ◽

Duration Of Surgery ◽

Minimally Invasive Access

Introduction: Increasing life expectancy in the western world and improvements in surgical techniques and postoperative care have resulted in a significant number of patients aged over 80 undergoing cardiac operations. At times of transapical and transfemoral AVR we aimed to evaluate the feasibility of partial sternotomy for patients over 80 years of age and to compare these results with a historical group of octogenarians who underwent aortic valve surgery via full sternotomy in our department between 1998 and 2006. Methods: 72 of the 275 patients (26.2 %) who underwent aortic valve replacement (AVR) after partial sternotomy between 8/2009 and 05/2013 were octogenarians. Mean age was 83.1 ± 3.9 years (group ps). We compared this group with 165 patients (mean age 81.6 ± 3.1 years) who underwent AVR via full sternotomy between 1998 and 2006 (group fs). Results: ICU- and hospital stay were significantly reduced in patients with partial sternotomy (ps: 28 ± 9 hours, 12.8 ± 4.7 days vs. fs: 59 ± 15 h, 14.7 ± 3.5 d, p<0.05). We found a higher in-hospital mortality in group fs, but without significance (4.2 vs. 2.8 % in ps). Duration of operation, of extracorporeal circulation, and of aortic cross-clamping was tendentially prolonged in patients with partial sternotomy (p>0.05). Necessity for re-operation due to bleeding was comparable in both groups (ps: 2.8 % vs. fs: 3.0 %). The incidence of postoperative complications did not differ significantly between both groups: neurological complications (ps: 2.8 vs. fs: 3.0 %), sternal wound infections (2.8 % vs. 2.4 %) and postoperative LCOS (4.2 % vs. 5.5 %). Conclusions: We could prove the feasibility of ministernotomy for aortic valve surgery for patients over 80 years of age. Despite a tendentially prolonged duration of surgery compared to procedures via full sternotomy, we found a comparable morbidity and a reduced mortality after partial sternotomy. From an economic perspective, the reduction of intensive care unit- and hospital stay after minimally invasive access was the most interesting finding. Moreover, our results after minimally invasive AVR have to be considered carefully when selecting patients for a conventional or for a TAVI procedure.

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