Abstract
Abstract
Purpose
This study aims to evaluate the perioperative outcomes of aortic valve replacement (AVR) via right anterior minithoracotomy (RAT) during the learning curve.
Methods
It was a retrospective, observational, cohort study of patients who underwent RAT AVR from June 2015 to April 2022. Primary outcomes measured were 30-day morbidity and mortality.
Results
A total of 107 consecutive patients underwent elective RAT AVR. Our patients were mostly male (78.5%), elderly (mean 68.7 years), and obese (34.6%). A majority of the patients (93.5%) were of low operative risk. Median cross-clamp and bypass times were 95 and 123 minutes respectively. There was a statistically significant correlation between increase in number of cases and decrease in operative time. All patients had no paravalvular leak at discharge. There were no operative cardiovascular mortality or major morbidity including stroke, myocardial infarction, renal failure requiring dialysis, or vascular complication. No patient required intraoperative conversion to full sternotomy for completion of AVR.
Conclusion
Our study demonstrated that RAT AVR can be safely introduced. The learning curve required in performing RAT AVR can be safely negotiated through training, previous experience in minimally invasive surgery, careful patient selection including use of preoperative computed tomography of the aorta, and introduction of sutureless/rapid deployment valves.
Funder
University of Western Australia
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,Surgery
Reference6 articles.
1. Shardey G, Tran L, Williams-Spence J, Solman N, McLaren J, Marrow N, et al. The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program National Annual Report 2020. Monash Uni, DEPM, 2021; Report No 14.
2. Bowdish ME, D’Agostino RS, Thourani VH, Schwann TA, Krohn C, Desai N, et al. The Society of Thoracic Surgeons adult cardiac surgery database: update on outcomes and research. Ann Thorac Surg. 2021;111:1770–80.
3. Kaspersen AE, Nielsen SJ, Orrason AW, Petursdottir A, Sigurdsson MI, Jeppsson A, et al. Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experience from SWEDEHEART. Eur J Cardiothorac Surg. 2021;60:233.
4. Cribier A, Eltchaninoff H, Tron C, Bauer F, Agatiello C, Sebagh L, et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol. 2004;43:698–703.
5. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695–705.