Is it safe to move away from a full sternotomy for aortic valve replacement?

Background Minimally invasive surgical approaches have gained popularity among patients and surgeons. The aim of this project was to assess the safety of initiating aortic valve replacement via an anterior right thoracotomy program. Methods Between May 2015 and May 2019, data of all isolated primary aortic valve replacements were extracted retrospectively from our prospectively collected database and categorized into conventional median sternotomy, hemisternotomy, and anterior right thoracotomy cases. In total, 661 patients underwent isolated primary aortic valve replacement, of whom 429 (65%) had a median sternotomy, 126 (19%) had a hemisternotomy, and 106 (16%) had an anterior right thoracotomy. Preoperative characteristics were similar in each of the three groups. Statistical testing of the surgical groups was undertaken using the chi-square test for categorical variables and one-way analysis of variance with Tukey post-hoc pairwise tests (where appropriate) for continuous variables, to identify differences between pairs of data. Results Cardiopulmonary bypass and crossclamp times were significantly longer in the anterior right thoracotomy group compared to the hemisternotomy and median sternotomy groups ( p < 0.001). Blood loss was significantly less and hospital stay significantly shorter in the hemisternotomy group compared to median sternotomy group but not the anterior right thoracotomy group. Mortality, stroke, renal, gastrointestinal and respiratory complications showed no statistical differences. Conclusion Surgical aortic valve replacement had a very low mortality and morbidity in our experience, and it is safe to start a minimal access program for aortic valve replacement.

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Surgical Approaches to Aortic Valve Replacement and Repair—Insights and Challenges

Interventional Cardiology Review ◽

10.15420/icr.2011.9.1.32 ◽

2011 ◽

Vol 9 (1) ◽

pp. 32 ◽

Cited By ~ 2

Author(s):

Basel Ramlawi ◽

Mahesh Ramchandani ◽

Michael J Reardon ◽

◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Treatment Approach ◽

Severe Aortic Stenosis ◽

Surgical Approaches ◽

Invasive Treatment ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Recent Developments

Since 1960, surgical aortic valve replacement (sAVR) had been the only effective treatment for symptomatic severe aortic stenosis until the recent development of transcatheter aortic valve replacement (TAVR). TAVR has offered an alternative, minimally invasive treatment approach particularly for patients whose age or co-morbidities make them unsuitable for sAVR. The rapid and enthusiastic utilization of this new technique has triggered some speculation about the imminent demise of sAVR. We believe that despite the recent advances in TAVR, surgical approach to aortic valve replacement has continued to develop and will continue to be highly relevant in the future. This article will discuss the recent developments and current approaches for sAVR, and how these approaches will keep pace with catheter-based technologies.

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Recent advances in aortic valve replacement

F1000Research ◽

10.12688/f1000research.17995.1 ◽

2019 ◽

Vol 8 ◽

pp. 1159 ◽

Cited By ~ 4

Author(s):

Cristiano Spadaccio ◽

Khalid Alkhamees ◽

Nawwar Al-Attar

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Median Sternotomy ◽

Surgical Aortic Valve Replacement ◽

Complete Excision ◽

Surgical Access ◽

Transcatheter Valve ◽

Transcatheter Valves

Aortic valve replacement has stood the test of time but is no longer an operation that is exclusively approached through a median sternotomy using only sutured prostheses. Currently, surgical aortic valve replacement can be performed through a number of minimally invasive approaches employing conventional mechanical or bioprostheses as well as sutureless valves. In either case, the direct surgical access allows inspection of the valve, complete excision of the diseased leaflets, and debridement of the annulus in a controlled and thorough manner under visual control. It can be employed to treat aortic valve pathologies of all natures and aetiologies. When compared with transcatheter valves in patients with a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. As our understanding of sutureless valves and their applicability to minimally invasive surgery advances, the invasiveness and trauma of surgery can be reduced and outcomes can improve. This warrants further comparative trials comparing sutureless and transcatheter valves.

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Status of cardiovascular surgery in Japan between 2017 and 2018: a report based on the Japan Cardiovascular Surgery Database. 3. Valvular heart surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320981459 ◽

2021 ◽

pp. 021849232098145

Author(s):

Tomonobu Abe ◽

Hiraku Kumamaru ◽

Kiyoharu Nakano ◽

Noboru Motomura ◽

Hiroaki Miyata ◽

...

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Operative Mortality ◽

Cardiovascular Surgery ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Right Thoracotomy ◽

First Time

Objectives We aimed to present data regarding the current status and trends of valvular heart surgeries in Japan from the Japan Cardiovascular Surgery Database for the 2017–2018. Methods We extracted data on cardiac valve surgeries performed in 2017 and 2018 from the Japan Cardiovascular Surgery Database. We determined the trend in the number of aortic valve replacement procedures from 2013 to 2018. The operative mortality rates were calculated for representative valve procedures stratified by age group. Data regarding minimally invasive procedures and transcatheter aortic valve replacement in the Japan Cardiovascular Surgery Database are also presented. Results In conjunction with the dramatic increase in the number of transcatheter aortic valve replacements in 2017 and 2018, surgical aortic valve replacement also increased from 26,054 to 28,202. The operative mortality rate in first-time valve procedures was 1.8% in isolated aortic valve replacement, 0.9% in isolated mitral valve repair, and 8.2% and 4.6% in mitral valve replacement with biological prostheses and with mechanical prostheses, respectively. Regarding minimally invasive procedures, 30.8% of first-time isolated mitral valve plasty procedures were performed by a right thoracotomy. Although patients who underwent surgery by a right thoracotomy had better clinical outcomes, it was also apparent that patients who underwent surgery by a right thoracotomy had lower operative risk profiles. The overall mortality rates after transcatheter aortic valve replacement and surgical aortic valve replacement were 1.5% and 1.8%, respectively. Conclusion We have reported benchmark data on heart valve surgery in 2017 and 2018 from the Japan Cardiovascular Surgery Database.

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