scholarly journals Early clinical outcomes of total thoracoscopic aortic valve replacement

2021 ◽  
Author(s):  
Chao Song ◽  
Shengli Jiang ◽  
Siming Zhu ◽  
YunLong Fan
Keyword(s):  
Mechanical Ventilation ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Elective Surgery ◽  
Relative Number ◽  
Valve Surgery ◽  
The Other ◽  
Field Exposure ◽  
Intraoperative Conversion

Background: With the promotion of minimally invasive concepts and advances in total thoracoscopic valve surgery, total thoracoscopic aortic valve surgery has become a new option for patients with aortic valve lesions. However, due to its anatomical characteristics, poor surgical field exposure and limited operating space, only a few centers have performed further studies on this procedure. Methods: We evaluate the safety and advantages of total thoracoscopic aortic valve replacement compared to the upper mini-sternotomy AVR group and the conventional AVR group with important perioperative data as well as early postoperative outcomes. Results: All patients successfully underwent elective surgery, with no intraoperative conversion or death occurring. Patients in the total thoracoscopy group had significantly prolonged CPB and aortic clamping (AC) times compared to the other two groups. The average Postoperative chest drainage in the first 24 h of the total thoracoscopic group was significantly less than the other two groups. The mean VAS pain score in the total thoracoscopic group was significantly less than the other two groups. In addition, the total thoracoscopic group had a significantly decreased ICU stay as well as the total hospital stay. Although the length of mechanical ventilation between groups did not show statistically significant differences, mechanical ventilation in the total thoracoscopy group had a smaller relative number. Conclusions: Despite the need for improvement, total thoracoscopic aortic valve replacement is safe, and may improve clinical outcome

Minimally Invasive Aortic Valve Surgery in Octogenarians: Reliable Option or Fallback Solution?

2020 ◽  
pp. 155698452097446
Author(s):  
Federico Cammertoni ◽  
Piergiorgio Bruno ◽  
Raphael Rosenhek ◽  
Natalia Pavone ◽  
Piero Farina ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Valve Surgery ◽  
Chest Drain ◽  
Blood Transfusions ◽  
Aortic Valve Surgery ◽  
Term Survival

Objective Aortic valve disease is more and more common in western countries. While percutaneous approaches should be preferred in older adults, previous reports have shown good outcomes after surgery. Moreover, advantages of minimally invasive approaches may be valuable for octogenarians. We sought to compare outcomes of conventional aortic valve replacement (CAVR) versus minimally invasive aortic valve replacement (MIAVR) in octogenarians. Methods We retrospectively collected data of 75 consecutive octogenarians who underwent primary, elective, isolated aortic valve surgery through conventional approach (41 patients, group CAVR) or partial upper sternotomy (34 patients, group MIAVR). Results Mean age was 81.9 ± 0.9 and 82.3 ± 1.1 years in CAVR and MIAVR patients, respectively ( P = 0.09). MIAVR patients had lower 24-hour chest drain output (353.4 ± 207.1 vs 501.7 ± 229.9 mL, P < 0.01), shorter mechanical ventilation (9.6 ± 2.4 vs 11.3 ± 2.3 hours, P < 0.01), lower need for blood transfusions (35.3% vs 63.4%, P = 0.02), and shorter hospital stay (6.8 ± 1.6 vs 8.3 ± 4.3 days, P < 0.01). Thirty-day mortality was zero in both groups. Survival at 1, 3, and 5 years was 89.9%, 80%, and 47%, respectively, in the CAVR group, and 93.2%, 82.4%, and 61.8% in the MIAVR group, with no statistically significant differences (log-rank test, P = 0.35). Conclusions Aortic valve surgery in older patients provided excellent results, as long as appropriate candidates were selected. MIAVR was associated with shorter mechanical ventilation, reduced blood transfusions, and reduced hospitalization length, without affecting perioperative complications or mid-term survival.

scholarly journals Totally endoscopic aortic valve replacement via an anterolateral approach using a standard prosthesis

2019 ◽  
Vol 30 (3) ◽  
pp. 424-430 ◽  
Author(s):  
Masayoshi Tokoro ◽  
Sadanari Sawaki ◽  
Takahiro Ozeki ◽  
Mamoru Orii ◽  
Akihiko Usui ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operating Time ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Intercostal Space ◽  
Anterolateral Approach ◽  
The Right

Abstract OBJECTIVES Totally endoscopic aortic valve replacement (AVR) is still a challenging operation, and only a few series reports exist in the literature. The purposes of this study were to establish a method for endoscopic AVR and evaluate its initial results. METHODS A total of 47 patients (median age 76 years, 17 men) underwent endoscopic AVR. The main wound was created in the right anterolateral 4th intercostal space through a 4-cm skin incision. No rib spreader was used. A 3-dimensional endoscope was inserted at the midaxillary line. A 5.5-mm trocar was inserted in the 3rd intercostal space, thus creating a 3-port setting similar to that used for endoscopic mitral valve surgery. A standard prosthesis was used, and the sutures were tied using a knot pusher. Results were compared with those of 157 patients who underwent right transaxillary AVR with direct vision plus endoscopic assist. RESULTS Patient backgrounds did not differ significantly between the 2 groups. No deaths occurred in the entire series. There was no conversion to thoracotomy or sternotomy in the endoscopic AVR group. The complication rate did not differ significantly between the 2 groups. The total operating time was significantly shorter in endoscopic AVR (188–206 min); the cardiopulmonary bypass time (130–128 min) and the cross-clamp time (90–95 min) did not differ significantly (median, endoscopic AVR, right transaxillary AVR). Two patients underwent endoscopic double-valve (aortic and mitral) surgery under the same conditions. CONCLUSIONS Endoscopic AVR was possible through 3 ports created in the right anterolateral chest, similar to the procedure for endoscopic mitral valve surgery. By adopting a common approach for both the aortic and the mitral valve operations, endoscopic double-valve surgery can be performed seamlessly.

THIRTY YEARS EXPERIENCE WITH HEART VALVE SURGERY: ISOLATED AORTIC VALVE REPLACEMENT

1996 ◽  
Vol 66 (12) ◽  
pp. 799-805 ◽  
Author(s):  
Justin R. Bessell ◽  
Georgina Gower ◽  
David R. Craddock ◽  
John Stubberfield ◽  
Guy J. Maddern
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Valve ◽  
Valve Surgery ◽  
Heart Valve Surgery

Management of a Protruding Right Coronary Artery Stent during Aortic Valve Replacement for Aortic Stenosis

2012 ◽  
Vol 7 (3) ◽  
pp. 213-216 ◽  
Author(s):  
Nnamdi Nwaejike ◽  
Christopher Rozario ◽  
Franco Sogliani
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Medical Care ◽  
Valve Replacement ◽  
Coronary Intervention ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Percutaneous Coronary

We describe the successful management of a stent protruding from the right coronary ostium into the aortic root in the setting of aortic valve replacement for aortic stenosis. Due to advances in medical care more elderly patients present for aortic valve surgery after percutaneous coronary intervention. Therefore, with an aging population due to advances in medical care, more patients will present for aortic valve surgery after percutaneous coronary intervention. We suggest a degree of caution before valve deployment in transcatheter aortic valve intervention or during annular manipulation in patients undergoing traditional aortic valve replacement with coexisting patent proximal stents.

scholarly journals Outcomes Amongst Obesity Class I, II, and III Patients Undergoing Minimally Invasive Aortic Valve Replacement

2021 ◽  
Author(s):  
Marlena Sabatino ◽  
NaYoung Yang ◽  
Fady Soliman ◽  
Joshua Chao ◽  
ALEXIS OKOH ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Class Ii ◽  
Valve Surgery ◽  
Class I ◽  
Obese Patients ◽  
Class Iii ◽  
Obesity Class

Background: Minimally invasive heart valve surgery has previously been shown to be safe and feasible in obese patients. Within this population, we investigated the effect of obesity class on the patient outcomes of minimally invasive aortic valve replacement (mini-AVR). Methods: A single center retrospective cohort study of consecutive patients with obese body mass indices (BMIs) who underwent mini-AVR between 2012 and 2018. Patients were stratified into 3 groups according to Centers for Disease Control and Prevention adult obesity classifications: Class I (BMI 30.0 to < 35.0), Class II (BMI 35.0 to < 40.0), and Class III (BMI ≥ 40.0). The primary outcomes were postoperative length of stay (LOS), 30-day mortality within, and cost. Results: Amongst 182 obese patients who underwent mini-AVR, LOS (Class I 4 [3-6] vs. Class II 4 [3-6] vs. Class III 5 [4-6] days; p=0.098) and costs (Class I $24,487 [$20,199-$27.480] vs. Class II $22,921 [$20,433-$27,740] vs. Class III $23,886 [$20,063-$33,800] USD; p=0.860) did not differ between obesity class cohorts. Postoperative 30-day mortality (Class I 2.83% [n=2] vs. Class II 0% [n=0] vs. Class III 0% [n=0]; p=0.763) was limited by an insufficient sample size relative to a low event rate but did not differ between patient cohorts. Conclusions: Mini-AVR is safe and feasible to perform for obese patients regardless of their obesity class. Patients with obesity should be afforded the option of minimally invasive aortic valve surgery regardless of their obesity class.

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