10. Minimally Invasive Endoscopic Aortic Valve Replacement: Early Results in Unselected Patients
Giovanni Domenico Cresce, Massimo Sella, Tommaso Hinna Danesi, Alessandro Favaro, Loris Salvador
Ospedale San Bortolo, Vicenza, Italy
Invited Discussant: *Joseph Lamelas
Objective: The surgical technique to perform aortic valve replacement (AVR) continues to evolve to reduce the surgical invasiveness and improve outcomes. Aim of this study was to describe our totally endoscopic technique and to evaluate its early results regardless of the type of prosthetic valve implanted and the preoperative patients characteristics.
Methods: From July 2013 to September 2018, 125 unselected patients (76 males, mean age 68.8±10.9 years, mean EuroScore II 1.51±1.39) underwent isolated endoscopic AVR due to a severe aortic valve stenosis in 99 cases and a severe insufficiency in 26 cases. The surgical access was a 3-4 cm working port in the second right intercostal space without insertion of costal retractor (no-rib spreading) and without right mammary artery sacrifice; three additional 5 mm ports for the introduction of a 30-degree optics, the Chitwood clamp and the vent line were used. Cardiopulmonary by-pass (CPB) was achieved through a femoro-femoral cannulation.
Results: All patients underwent endoscopic AVR. Standard stended bioprosthesis, Edwards Rapid Deployment Intuity Elite and Sorin Perceval Suturless Bioprosthesis were used in 56, 23 and 46 cases respectively. Overall mean cross-clamping and CPB times were 87.5±22.1 and 126.1±28.4 minutes respectively and they significantly vary in cases where a Perceval or a Rapid Deployment Bioprotstheses or a Stented valve was implanted (69.1±15.1 and 106.2±21.8 minutes vs 93.2±15.1 and 135.5±21.8 minutes vs 100.6±17.2 and 138.9±21.9 minutes respectively). No conversion to full sternotomy was necessary. Mean ventilation and ICU times and hospital stay were 10.9±39.3 hours, 45.9±58.4 hours and 8.3±9.3 days respectively. Thirty-day mortality occurred in 1 patients (0.8%). One patient (0.8%) needed a re-exploration for bleeding and three patients (2.4%) required a new permanent pacemaker implantation. No major neurologic events were observed. No paravalvular leakage was detected at discharge.
Conclusions: This study shows that endoscopic AVR is safe and feasible with favorable operative results, significantly reducing the surgical invasiveness. With further experience this approach may become the technique of choice for all patients undergoing surgical AVR. The use Sorin Perceval Suturless bioprosthesis significantly reduces the aortic cross clamp and the CPB times.