12263 Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany.
40628 Division of Cardiac Surgery, University Clinic of Cardiac Surgery, Leipzig Heart Centre, Leipzig, Germany.
Innovations (Phila). 2021 Mar-Apr;16(2):169-174. doi: 10.1177/1556984520977212. Epub 2020 Dec 23.
Right anterior minithoracotomy is a promising technique for aortic valve replacement and has shown excellent results in terms of mortality and morbidity. Against this background, we analyzed our institutional experience in this technique during the last 3 years.
Between April 2017 and March 2019, 513 consecutive all comers with aortic valve disease underwent video-assisted minimally invasive aortic valve replacement through a 3-cm skin incision as right anterior minithoracotomy at our institution. A camera and automatic fastener technology were used for the valve implantation in all patients. Clinical data were prospectively entered into our institutional database.
Cardiopulmonary bypass time accounted for 68 ± 24 min and the myocardial ischemic time 38 ± 12 minutes. Thirty-day mortality and overall mortality was 0.4% (2 patients) and 1.4% (7 patients), respectively. Postoperative cerebrovascular events were noted in 8 patients (1.5%). Intensive care stay and hospital stay were 2 ± 2 and 9 ± 7 days, respectively. Pacemaker implantation, injury of the right internal mammary artery, and conversion to full sternotomy were noted in 7 patients (1.4%), 3 patients (0.6%), and 1 patient (0.2%), respectively. Paravalvular leak need to intervention was noted in 2 patients (0.4%). Rethoracotomy rate was 2% (11 patients). Transient postoperative dialysis was necessary for 14 patients (3%).
Video-assisted minimally invasive aortic valve replacement through the right anterior minithoracotomy is a safe approach and yields excellent outcomes in high-volume centers. The use of a camera and automatic fastener technology facilitates this procedure.
右前小开胸术是一种有前途的主动脉瓣置换技术，在死亡率和发病率方面显示出了优异的结果。在此背景下，我们分析了我们机构在过去 3 年中应用该技术的经验。
2017 年 4 月至 2019 年 3 月，我院 513 例连续就诊的主动脉瓣疾病患者采用右前小开胸术（胸骨旁 3cm 切口），通过视频辅助微创技术进行主动脉瓣置换。所有患者均采用摄像和自动吻合技术进行瓣膜植入。临床数据前瞻性地录入我院数据库。
体外循环时间为 68±24 分钟，心肌缺血时间为 38±12 分钟。30 天死亡率和总死亡率分别为 0.4%（2 例）和 1.4%（7 例）。术后发生脑血管事件 8 例（1.5%）。重症监护病房停留时间和住院时间分别为 2±2 天和 9±7 天。7 例（1.4%）患者需植入起搏器，3 例（0.6%）患者损伤右内乳动脉，1 例（0.2%）患者需转为全胸骨切开术。2 例（0.4%）患者需干预瓣周漏。再次开胸率为 2%（11 例）。14 例（3%）患者需短暂性术后透析。
在高容量中心，经右前小开胸术的视频辅助微创主动脉瓣置换术是一种安全的方法，可获得优异的结果。摄像和自动吻合技术的应用有助于该手术的开展。
