Introduction: Minimally invasive approach to Aortic Valve
Replacement (AVR) is increasingly accepted as a valid alternative
to full sternotomy approach, as to reduce operative trauma with
the final aim to improve post-operative outcomes. The aim of this
work is to evaluate the feasibility of minimally invasive aortic valve
surgery through a right mini-thoracotomy, and hence to minimize the
surgical access to achieve better cosmetic results, less postoperative
discomfort and faster recovery while maintaining the same level of
safety and favorable results as with conventional surgery.
Methods: In this study a 150 patients with Aortic Valve Disease
(AVD) requiring aortic valve surgery were none randomly selected.
The study was performed at Benha University Hospital & the Armed
Forces Hospitals. Seventy five patients underwent aortic valve surgery
by traditional median sternotomy with central cannulation (group B),
the other seventy five patients by right mini-thoracotomy on 2nd or 3rd
right intercostal space with peripheral femoral cannulation (group A).
Endpoints were overall postoperative complications, major adverse
cardiac related complications, use of blood products and need for
transfusions, bypass time and cross clamp time, ventilation time and
length of hospital-stay.
Results: Minimally invasive AVR was associated with a significant
reduction in need for blood and blood products transfusions, as well as
postoperative cardiac and non-cardiac complications. Post-operative
pain was significantly reduced in the mini-invasive group, a trend to
lower mean ventilation times, ICU stay and hospital-stay in the miniinvasive group was also detected.
Conclusion: Minimally invasive aortic valve surgery has evolved
into a well tolerated, efficient surgical treatment option in experienced
centers, providing greater patient satisfaction and lower complication
rates. Potential advantages of Minimally Invasive Aortic Valve
Replacement (MIAVR) arise from the concept that patient morbidity
and potential mortality could be reduced without compromising the
excellent results of the conventional procedure and include improved
cosmetic results, safer access in the case of re-operation, less postoperative bleeding, less blood transfusions, lower intensive care unit
and in-hospital stays, as well as the absence of sternal wound infection. |
