MINIMALLY INVASIVE AORTIC-VALVE REPLACEMENT WITHOUT STERNOTOMY - EXPERIENCE WITH THE FIRST 50 CASES

Objective: The method of replacing the aortic valve via a mini-thoraco tomy has been reported in the recent literature. Although this strateg y has clear advantages, further refinements of the process make the pr ocedure even less invasive. Methods: Aortic valve replacement was perf ormed in 50 patients whose age ranged between 49 and 82 years, averagi ng 68 +/- 8.3 years. As access route, a right parasternal mini-thoraco tomy of about 8 cm, without rib resection was used. Cardiopulmonary by pass was connected through the same access. Standard surgical techniqu es,md equipment were employed. In all patients a mechanical prosthesis was implanted. Results: There were neither intraoperative complicatio ns nor hospital death. All patients could be discharged home at an ave rage of 10 +/- 3 days postoperatively. Cardiopulmonary bypass; time, a ortic cross-clamp time, total operation time averaged 118 +/- 32, 70 /- 21, 180 +/- 45 min, respectively. Four patients could be extubated in the operative theater, the others on the intensive care units at an average of 12 +/- 6 h, postoperatively. One patient with a very thin aortic wall sustained a severe bleeding from the aortic cannulation si te during an hypertensive crisis, just after extubation. Re had to be re-entered immediately via a median sternotomy. A second patient, who was initially operated on because: of a Boride aortitis, had a limited periprosthetic leak 2 months postoperatively. The leak was repaired v ia a median sternotomy. Drainage lost and blood substitution averaged 751 +/- 400 and 274 +/- 390, respectively. Conclusions: The advantages of the present method include further reduction of hospital trauma, p reservation of chest wall integrity, early mobilization and rehabilita tion of the patient. Surgical technical improvements include avoidance of groin cannulation, simpler equipment, and an easy access in case o f reoperation. (C) 1998 Elsevier Science B.V. All rights reserved.