Minimally invasive aortic valve replacement without sternotomy. Experience with the first 50 cases
| Autor: | Carmine Minale, Frank P. Uckmann, E Schmitz, Hans J. Reifschneider |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Aortic valve Sternum medicine.medical_specialty Time Factors medicine.medical_treatment Aortic Valve Insufficiency Prosthesis law.invention Aortic valve replacement law Intensive care medicine Cardiopulmonary bypass Humans Minimally Invasive Surgical Procedures Aged Heart Valve Prosthesis Implantation business.industry Aortic Valve Stenosis General Medicine medicine.disease Rib resection Surgery medicine.anatomical_structure Thoracotomy Parasternal line Median sternotomy Aortic Valve Heart Valve Prosthesis Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 14:126-129 |
| ISSN: | 1010-7940 |
| Popis: | Objective: The method of replacing the aortic valve via a mini-thoracotomy has been reported in the recent literature. Although this strategy has clear advantages, further refinements of the process make the procedure even less invasive. Methods: Aortic valve replacement was performed in 50 patients whose age ranged between 49 and 82 years, averaging 68 ∠ 8.3 years. As access route, a right parasternal mini-thoracotomy of about 8 cm, without rib resection was used. Cardiopulmonary bypass was connected through the same access. Standard surgical techniques and equipment were employed. In all patients a mechanical prosthesis was implanted. Results: There were neither intraoperative complications nor hospital death. All patients could be discharged home at an average of 10 ∠ 3 days postoperatively. Cardiopulmonary bypass time, aortic cross-clamp time, total operation time averaged 118 ∠ 32, 70 ∠ 21, 180 ∠ 45 min, respectively. Four patients could be extubated in the operative theater, the others on the intensive care units at an average of 12 ∠ 6h , postoperatively. One patient with a very thin aortic wall sustained a severe bleeding from the aortic cannulation site during an hypertensive crisis, just after extubation. He had to be re-entered immediately via a median sternotomy. A second patient, who was initially operated on because of a floride aortitis, had a limited periprosthetic leak 2 months postoperatively. The leak was repaired via a median sternotomy. Drainage lost and blood substitution averaged 751 ∠ 400 and 274 ∠ 390, respectively. Conclusions: The advantages of the present method include further reduction of hospital trauma, preservation of chest wall integrity, early mobilization and rehabilitation of the patient. Surgical technical improvements include avoidance of groin cannulation, simpler equipment, and an easy access in case of reoperation. © 1998 Elsevier Science B.V. All rights reserved |
| Databáze: | OpenAIRE |
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