A Contemporary Approach to Reoperative Aortic Valve Surgery

2017 ◽  
Vol 12 (3) ◽  
pp. 197-200
Author(s):  
Deane E. Smith ◽  
Michael S. Koeckert ◽  
Patrick F. Vining ◽  
Elias A. Zias ◽  
Eugene A. Grossi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Minimally Invasive ◽  
Preoperative Evaluation ◽  
Valve Surgery ◽  
Surgical Approaches ◽  
Aortic Valve Surgery ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Valvular Surgery ◽  
Effective Manner

Objective Although the benefits of minimally invasive valvular surgery are well established, the applicability of extending these techniques to reoperative aortic valve surgery is unknown. We evaluated our experience with a minimally invasive approach to this patient population. Methods From January 2010 to September 2015, 21 patients underwent reoperative isolated aortic valve replacement via a minimally invasive approach by a single surgeon. All patients had preoperative evaluation with computerized tomography and coronary catheterization. Surgical approaches were right anterior thoracotomy (6/21) or upper hemisternotomy (15/21). Central aortic cannulation was preferred with femoral artery cannulation used in four patients (19%). In patients with left internal mammary artery (LIMA) grafts, no attempt to dissect or occlude the graft was made. Cold blood cardioplegia was administered antegrade (12/21) or retrograde (9/21); systemic cooling with a mean low temperature of 27.5 °C was employed. Results Mean age was 75.1 years with a range from 33 to 92 years, and 67% (14/21) were male. All procedures were completed with a minimally invasive approach. Mean ± SD cross-clamp time was 51.5 ± 9.2 minutes. Fourteen patients had patent LIMA grafts. No aortic, LIMA, or cardiac injuries occurred. There were no hospital deaths nor occurrences of perioperative myocardial infarction, stroke, wound infection, renal failure, or endocarditis/sepsis. One patient required a reoperation for bleeding. Sixty-two percent of patients were discharged to home; mean ± SD length of stay was 6 ± 3 days. Conclusions With appropriate preoperative evaluation and careful surgical planning, a minimally invasive approach to reoperative aortic valve surgery can be performed in a safe and effective manner.

scholarly journals Inaugural experience and early results of minimally invasive approach in cardiac surgery in Auvergne region, France

2020 ◽  
Vol 12 (2) ◽  
pp. 84-89
Author(s):  
Adama Sawadogo ◽  
Hoang Nam Nguyen ◽  
Nicolas D'Ostrevy ◽  
Lionel Camilleri ◽  
Kasra Azarnoush
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Valve Surgery ◽  
Medium Size ◽  
Aortic Valve Surgery ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Introduction : Minimally invasive approach in cardiac surgery has become an established and common technique in many cardiac surgery centres throughout the world. We report how we safely introduced minimally invasive approach in cardiac surgery in our department and we aim to demonstrate that this approach is feasible in any medium-size cardiac surgical centre. Methods: it consisted of retrospective and descriptive study on 60 patients who underwent minimally invasive mitral valve (45) or aortic valve surgery (15) from January 2017 to Februry 2018. The approach was 3 to 6-cm right thoracotomy through the 4th and 5th intercostal space. The Cor-KnotTM system was used to tie the knots of the prosthesis in case of mitral valve replacement and aortic valve replacement and the ring if mitral valve repair. Results: There was no conversion of thoracotomy to sternotomy. The average duration in ICU was 4.3± 2.3 days and 3.3 ± 1.5 respectively for mitral and aortic valve surgery. Four mitral patients and 1 aortic patient were reoperated for bleeding. No in-hospital death was observed. The postoperative discharge echocardiogram was normal in 95.6% of the mitral valve patients the trans-aortic mean gradient for the aortic valve patients was 16.3 ± 6 mm Hg. The thirty-day mortality was zero. In the majority of the patients, the scar of the thoracotomy were almost unseen. Conclusion: It is possible to safely implement this new approach in any mid-size cardiac centers. The use of modern technology such as 3D video and Cor Knot allows achievement of excellent short term outcomes.

Myocardial Protection in Mitral Valve Surgery: Comparison Between Minimally Invasive Approach and Standard Sternotomy

2018 ◽  
Vol 32 (2) ◽  
pp. 656-663 ◽  
Author(s):  
Jean-Sébastien Lebon ◽  
Pierre Couture ◽  
Annik Fortier ◽  
Antoine G. Rochon ◽  
Christian Ayoub ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Myocardial Protection ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Sutureless Aortic Valve Implantation through an Upper V-Type Ministernotomy: An Innovative Approach in High-Risk Patients

2013 ◽  
Vol 8 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Giovanni Concistrè ◽  
Antonio Miceli ◽  
Francesca Chiaramonti ◽  
Pierandrea Farneti ◽  
Stefano Bevilacqua ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Mean ◽  
Valve Implantation

Objective Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients. Methods Between May 2010 and May 2011, thirteen patients with severe aortic stenosis underwent aortic valve replacement with the 3f Enable bioprosthesis through an upper V-type ministernotomy interrupted at the second intercostal space. The mean ± SD age was 77 ± 3.9 years (range, 72–83 years), 10 patients were women, and the mean ± SD logistic EuroSCORE was 15% ± 13.5%. Echocardiography was performed preoperatively, at postoperative day 1, at discharge, and at follow-up. Clinical data, adverse events, and patient outcomes were recorded retrospectively. The median follow-up time was 4 months (interquartile range, 2–10 months). Results Most of the implanted valves were 21 mm in diameter (19–25 mm). The CPB and ACC times were 100.2 ± 25.3 and 66.4 ± 18.6 minutes. At short-term follow-up, the mean ± SD pressure gradient was 14 ± 4.9 mm Hg; one patient showed trivial paravalvular leakage. No patients died during hospital stay or at follow-up. Conclusions The 3f Enable sutureless bioprosthesis implanted in minimally invasive approach through an upper V-type ministernotomy is a feasible, safe, and reproducible procedure. Hemodynamic and clinical data are promising. This innovative approach might be considered as an alternative in high-risk patients. Reduction of CPB and ACC time is possible with increasing of experience and sutureless evolution of actual technology.

One incision, two cannulations for minimally invasive aortic valve surgery

2015 ◽  
Vol 182 ◽  
pp. 97 ◽  
Author(s):  
Shuyang Lu ◽  
Lai Wei ◽  
Xiaoning Sun ◽  
Chunsheng Wang
Keyword(s):  
Aortic Valve ◽  
Minimally Invasive ◽  
Valve Surgery ◽  
Aortic Valve Surgery

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

Circulation ◽  
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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