Aortic valve disease is a most common disorder, comparing to other valvular heart diseases in the developed countries. Surgical aortic valve replacement is the gold standard treatment for AVD patients. Minimally invasive AVR through right thoracotomy gives a chance to treat a patient with small incision, with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. MIAVR provides early- and long-term benefits: less blood loss, decreased blood transfusions, faster improvement of postoperative respiratory function, decreased chance of infection, absence of incidence of sternal wound complications, a shorter hospital stay, safer reoperation. Despite to pitfalls: technically very demanding, not appropriate for every patient, prolonged CPB and ACC time, expensive technology, given it’s all aforecited benefits, the method may be considered the standard of care for isolated aortic valve disease.
Selection of patient is according to indications provided in ESC and ACC/AHA guidelines. Mandatory to take into consideration contraindications of surgery, such as: ascending aortic disease, Bicuspid aortic valve, prior sternotomy or cardiac/lung surgical procedures, severe chest wall deformities, morbid obesity, severe LV dysfunction and significant other valve disorder or coronary disease.
The most common MIAVR approaches are upper partial sternotomy and right anterior minithoracotomy. Right Thoracotomy is performed with a 4−6 cm skin incision over the right 2-3 intercostal space near the sternal border . Valve replacement is performed in standard fashion with TEE guidance. The chest incision is closed routinely. Patients are discharged in 4-8 days after operation. Follow-up TTE is performed in a week and 1, 3, 6, 12 months.
Our experience from 2015 year is -successfully performed 56 Minimally invasive AVR, in patients with mean age of 63 years (from 40 to 86 years old patients). Overall mortality (n. patients,%)- 0(0); Stroke (n,%)- 0(0); Re-exploration for bleeding (n,%) -0(0); Blood Transfusions (ICU) (n,%) – 9(%); Atrial Fibrillation (n,%)- 9 (16.0%); Ventilation time, hours (median, range) - 0.30-6 h (3.15 h); Hospital stay, days (median, range) - 4-8 (6.0); Conversion to FS (n,%) - 0 (%); Conversion to MS (n,%) - 1 (1,78%); Mean CPB time (min+/-) – 80 +/ -16; Mean Cross clamp (min+/-) -50 +/ -13.
Based on our experience, as well as inference from past general surgical history, our belief that postoperative quality of life, including satisfaction with the procedure, return to work, level of discomfort, performance of daily activities- are improved by these minimally invasive approaches.
Aortic valve disease ; Aortic valve replacement; Mini invasive surgery; Minithoracotomy; Mini invasive Right Thoracotomy.