SINGLE ACCESS FOR MINIMALLY INVASIVE AORTIC-VALVE REPLACEMENT

Background. The method of replacing the aortic valve via a minithoraco 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 27 patients via a right parasternal minithoracotomy without r ib resection. Cardiopulmonary bypass was connected through the same ac cess site. Standard surgical technique and equipment were employed. Re sults. There were no intraoperative complications. All patients surviv ed and could be discharged home within a week, except 1, Cardiopulmona ry bypass time, aortic cross-clamp time, and total operating time aver aged 114 +/- 26, 76 +/- 19, and 190 +/- 40 minutes, respectively. Thre e patients could be extubated in the operative theater, the others in the intensive care unit at an average of 10 +/- 7 hours postoperativel y. Chest drainage lost averaged 430 +/- 380 mL. Conclusions. The advan tages of this method include further reduction of surgical trauma, ear ly mobilization, and rehabilitation of the patient. Surgical technical improvements include avoidance of groin cannulation, simpler equipmen t, safe venting of the left ventricle, and preservation of chest wall integrity. (C) 1997 by The Society of Thoracic Surgeons.