Ultra fast-track minimally invasive aortic valve replacement: going beyond reduced incisions.

Aortic valve replacement (AVR) via a median sternotomy approach has been largely reported to be safe and long-term efficacious, and currently represents the 'gold standard' approach for aortic stenosis treatment. However, aortic valve surgery has undergone continuous development over the last years, involving less invasive techniques and new technologies to reduce the traumatic impact of the intervention and extend the operability toward increasingly high-risk patients. Indeed, minimally invasive AVR and transcatheter aortic valve replacement caseload have steadily increased leading to a paradigm shift in the treatment of aortic valve disease. In this setting, we have established a multidisciplinary minimally invasive programme to treat patients who require AVR. Herein, we present our approach including (i) reduced chest incision (through a J ministernotomy), aiming to reduce the traumatic impact of the surgical procedure, to decrease blood loss, postoperative pain and wound complications and to increase patient's satisfaction; (ii) rapid-deployment AVR, to reduce operative times, to facilitate minimally invasive approach and to improve haemodynamic outcomes; (iii) minimal invasive extracorporeal circulation system, to improve end-organ protection, to decrease systemic inflammatory response and to promote fast-track anaesthesia and (iv) ultra fast-track anaesthesia, to decrease the rate of postoperative complications and assure better and earlier recovery.