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Thorac Cardiovasc Surg 2016; 64(05): 392-399
DOI: 10.1055/s-0035-1566129
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Perioperative Outcomes of Minimally Invasive Aortic Valve Replacement through Right Anterior Minithoracotomy

Jarosław Stoliński
1   Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland
,
Kamil Fijorek
2   Department of Statistics, Cracow University of Economics, Cracow, Poland
,
Dariusz Plicner
1   Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland
,
Grzegorz Grudzień
1   Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland
,
Paweł Kruszec
1   Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland
,
Robert Musiał
3   Department of Anesthesiology and Intensive Therapy, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland
,
Janusz Andres
3   Department of Anesthesiology and Intensive Therapy, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland
› Author Affiliations
Further Information

Publication History

18 August 2015

14 September 2015

Publication Date:
04 November 2015 (online)

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Abstract

Background The aim of the study was to analyze perioperative outcomes after minimally invasive aortic valve replacement through right anterior minithoracotomy (RAT-AVR). Patient selection criteria, anesthesia protocol, and surgical technique are presented.

Methods A retrospective analysis of 194 patients electively scheduled for RAT-AVR was performed between January 2009 and June 2013. For preoperative planning, computed tomography was performed.

Results Among studied patients, there were 48.5% females and 51.5% males with a mean age of 69.9 ± 9.2 years. The predicted mortality calculated with EuroSCORE II was 3.2 ± 0.9%, and observed mortality of RAT-AVR patients was 1.5%. Finally, RAT-AVR surgery was performed on 97.9% of patients (n = 190). Reasons for conversions to median sternotomy were bleeding from aortotomy site (n = 4) and from the right ventricle after epicardial pacing wire placement (n = 1), pleural adhesions (n = 2), and ascending aorta hidden under the sternum (n = 2). The second intercostal space was chosen for surgical access in 97.9% of patients.

There were 3.6% reoperations for bleeding: aortotomy place (n = 1), epicardial pacing wire placement (n = 3), right lung tear (n = 2), and intercostal vessels (n = 1). The intensive care unit and hospital length of stays were 1.3 ± 1.2 and 5.7 ± 1.4 days, respectively. Strokes were present in 1.5% of patients. The perioperative complications rate diminished with time, occurring in 44.9% of the patients between 2009 and 2010 and in 15.6% of patients in 2013.

Conclusions RAT-AVR can be safely performed without increased morbidity and mortality. Reduced complication rates over time reflect a learning curve.

Keywords

aortic valve - minimally invasive surgery - minithoracotomy - valve surgery
 

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