Cor Vasa 2018, 60(6):e589-e596 | DOI: 10.1016/j.crvasa.2017.12.007

Our experience with surgical minimally invasive aortic valve replacement

David Nešpor^*, Jiří Ondrášek, Jan Štěrba, Tomáš Kára, Petr Němec

Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

Background: In the context of the development of modern cardiac valve interventional methods (TAVI, TMVI, MitraClip), miniinvasivity in cardiac surgery is becoming increasingly important. An alternative approach to complete sternotomy in isolated aortic valve replacement (AVR) is access from anterior thoracotomy or upper ministernotomy. In CKTCH Brno, an isolated aortic valve replacement (AVR) from the upper hemisternotomy (UHS) is performed from 2013 onwards.

Methods: Between 2013 and 2016, isolated AVR was performed in our institution in 666 patients. Full median sternotomy approach was used in 565 patients, minimally invasive approach (UHS) in 101 patients. In the ministernotomy group, classical biological or mechanical prosthesis was implanted in 55 patients; in 46 patients we used rapid deployment (sutureless) bioprosthesis Sorin Perceval S. In our study we compare the results of full sternotomy and hemisternotomy approach and also describe our surgical technique of minimally invasive aortic valve replacement.

Results: We registered gradual increase in minimally invasive AVR between 2013 and 2016 (9 patients in 2013, 59 patients in 2016). The combined hospitalization and 30-day mortality was 0.53% (3 patients) in the full sternotomy group and 0.99% (1 patient) in the ministernotomy group. In the most risky patients, we indicated ministernotomy with implantation of rapid deployment bioprosthesis (EuroSCORE II 3.0 vs. 1.6 in the group of patients with full sternotomy AVR). As published, we confirmed longer aortic cross clamp time (AoX) and length of extracorporal circulation (ECC) in the patients with ministernotomy and implantation of sutured aortic prosthesis in comparison with full sternotomy AVR. Conversely, shorter AoX time and ECC time was observed in patients with rapid deployment prosthesis implantation from ministernotomy. We also recorded smaller postoperative blood loss in patients with ministernotomy approach. The other monitored parameters were comparable.

Conclusion: In this study we describe our technique and results of minimally invasive aortic valve replacement in our institution. Based on our results, we evaluate this technique as safe and well reproducible.

Keywords: Aortic valve replacement; Cardiac surgery; Minimally invasive; Ministernotomy

Received: September 28, 2017; Accepted: December 13, 2017; Published: December 1, 2018  Show citation