Early results of minimally invasive aortic valve replacement. Experience with the first 34 cases.

Background: The method of replacing the aortic valve via a minithoracotomy has been reported in the recent literature. This strategy has clear advantages. However, further refinements of the process make the procedure even less invasive.

Methods: Aortic valve replacement was performed in 34 patients whose age ranged from 49 to 82 years, averaging 69 +/- 8 years. As access route, a right parasternal minithoracotomy about eight cm long and without rib resection was used. Cardiopulmonary bypass was connected through the same access. The standard surgical technique and equipment were employed.

Results: There were neither intraoperative complications nor hospital death. All patients, except two could be discharged home within one week. Cardiopulmonary bypass time, aortic cross-clamp time, and total operation time averaged 110 +/- 25, 73 +/- 19, and 183 +/- 38 minutes, respectively. Three patients could be extubated in the operating theater, and the others on the intensive care units at an average of 9 +/- 7 hours postoperatively. One patient had to be re-entered immediately after extubation because of a bleeding from the aortic cannulation site. A second patient, who was initially operated because of a florid aortitis, had a limited periprosthetic leak two months postoperatively which was repaired thereafter.

Conclusions: The advantages of the present method include further reduction of surgical trauma, preservation of chest wall integrity, early mobilization, recovery and rehabilitation of the patient. Improvements in the surgical technique include avoidance of groin cannulation, simpler equipment, and an easy access through a mid-sternotomy in case of reoperation.