Minimally Invasive Endoscopic Aortic Valve Replacement: Operative Results

Autor: Giovanni Domenico Cresce, Loris Salvador, Massimo Sella, Alessandro Favaro, Tommaso Hinna Danesi
Rok vydání: 2019
Předmět:
Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
Time Factors
030204 cardiovascular system & hematology
Prosthesis Design
Severity of Illness Index
law.invention
03 medical and health sciences
0302 clinical medicine
Port (medical)
Postoperative Complications
Aortic valve replacement
law
Risk Factors
Cardiopulmonary bypass
Medicine
Humans
Myocardial infarction
Aged
Retrospective Studies
Bioprosthesis
Heart Valve Prosthesis Implantation
business.industry
Thoracic Surgery
Video-Assisted
Hemodynamics
Atrial fibrillation
General Medicine
Aortic Valve Stenosis
Recovery of Function
Middle Aged
medicine.disease
Sutureless Surgical Procedures
Surgery
Clamp
medicine.anatomical_structure
Treatment Outcome
030228 respiratory system
Aortic Valve
Heart Valve Prosthesis
Breathing
Female
Intercostal space
Cardiology and Cardiovascular Medicine
business
Zdroj: Seminars in thoracic and cardiovascular surgery. 32(3)
ISSN: 1532-9488
Popis: To describe our endoscopic aortic valve replacement (E-AVR) technique and to evaluate its early results regardless of the type of prosthetic valve implanted and the patients’ characteristics. From July 2013 to September 2018, 125 patients (76 males, mean age 68.8 ± 10.9 years, mean EuroScore II 1.51 ± 1.39) underwent isolated E-AVR due to a severe stenosis in 99 cases and insufficiency in 26 cases. The surgical access was a 3–4 cm working port in the second right intercostal space with no rib-spreading and 3 additional 5 mm miniports for the introduction of a 30-degree thoracoscope, the Chitwood clamp, and the vent line. Cardiopulmonary bypass (CPB) was achieved through a femoro-femoral cannulation. All patients successfully underwent E-AVR. Stended bioprostheses were implanted in 56 cases, Rapid Deployment and Sutureless valves in 23 and 46 cases, respectively. Mean cross-clamping and CPB times were 87.5 ± 22.1 and 126.1 ± 28.4 minutes, respectively, and a significant difference between the types of prostheses was observed: 69.1 ± 15.1 and 106.2 ± 21.8 minutes (Sutureless) vs 93.2 ± 15.1 and 135.5 ± 21.8 minutes (Rapid Deployment) vs 100.6 ± 17.2 and 138.9 ± 21.9 minutes (Stented). Mean ventilation and ICU times and hospital stay were 10.9 ± 39.3 hours, 45.9 ± 58.4 hours, and 8.3 ± 9.3 days, respectively. Thirty-day mortality was 0.8%. One patient (0.8%) needed a re-exploration for bleeding and 3 patients (2.4%) required a new permanent pacemaker implantation. No major neurologic events were observed. No paravalvular leakage was detected at discharge. E-AVR is associated with low mortality and few complications. Sutureless bioprostheses significantly reduce cross-clamping and CPB times. In dedicated centers, this approach may become a valid alternative to other minimally invasive techniques.
Databáze: OpenAIRE
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