Aortic Valve Replacement Through a Minimally Invasive Approach: Preoperative Planning, Surgical Technique, and Outcome

Background. This study reports the experiences of minimally invasive aortic valve replacement (MIAVR) through a right minithoracotomy performed in the past 26 months and describes the surgical technique, the learning curve, the complication rate, and the patient outcomes. Methods. From March 2006 to June 2008, 172 patients (113 men; mean age, 71 +/- 12 years) were scheduled for MIAVR (6- to 7-cm incision). Multislice computed tomography (MSCT) imaging was used for surgical planning in 139. Aortic cannulation/clamping were performed through a right-sided minithoracotomy and venous cannulation percutaneously through the groin. For obtaining optimal intercostal space (ICS) distances between the incision to the aorta and cardiac structures, 2- and 3-dimensional MSCT images were evaluated. Results. Operations were done in 171 patients. MIAVR was successfully performed in 160 (94%). Six patients underwent a conventional operation due to adhesions in 4, small diameter of aortic annulus (17 mm) in 1, and concomitant coronary artery disease in 1. One patient was considered nonoperable. After CT-planning choice of second ICS in 17%, third in 81%, and fourth in 1%. Five conversions to sternotomy were necessary. Intraoperative and postoperative complications occurred in 20 patients, including 1 death. Overall cardiopulmonary bypass was 158 +/- 41 min and cross-clamp time was 107 +/- 26 min. No blood products in 43% of MIAVR patients. Mean hospital length of stay was 10 +/- 3 days. Conclusions. MIAVR demonstrates excellent results. A considerably reduced complication rate in the course was noted. MSCT for preoperative planning is helpful for an improved mental preparation and for an accurate surgical strategy, including optimal access.