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a Clinic for Cardiovascular Surgery, Zurich, Switzerland
b Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
c Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
Accepted for publication August 6, 2009.
* Address correspondence to Dr Plass, Clinic for Cardiovascular Surgery Ramistr. 100, Zurich, 8091, Switzerland (Email: andre.plass{at}usz.ch).
Background: This study reports the experiences of minimally invasive aortic valve replacement (MIAVR) through a right minithoracotomy performed in the past 26 months and describes the surgical technique, the learning curve, the complication rate, and the patient outcomes.
Methods: From March 2006 to June 2008, 172 patients (113 men; mean age, 71 ± 12 years) were scheduled for MIAVR (6- to 7-cm incision). Multislice computed tomography (MSCT) imaging was used for surgical planning in 139. Aortic cannulation/clamping were performed through a right-sided minithoracotomy and venous cannulation percutaneously through the groin. For obtaining optimal intercostal space (ICS) distances between the incision to the aorta and cardiac structures, 2- and 3-dimensional MSCT images were evaluated.
Results: Operations were done in 171 patients. MIAVR was successfully performed in 160 (94%). Six patients underwent a conventional operation due to adhesions in 4, small diameter of aortic annulus (17 mm) in 1, and concomitant coronary artery disease in 1. One patient was considered nonoperable. After CT-planning choice of second ICS in 17%, third in 81%, and fourth in 1%. Five conversions to sternotomy were necessary. Intraoperative and postoperative complications occurred in 20 patients, including 1 death. Overall cardiopulmonary bypass was 158 ± 41 min and cross-clamp time was 107 ± 26 min. No blood products in 43% of MIAVR patients. Mean hospital length of stay was 10 ± 3 days.
Conclusions: MIAVR demonstrates excellent results. A considerably reduced complication rate in the course was noted. MSCT for preoperative planning is helpful for an improved mental preparation and for an accurate surgical strategy, including optimal access.
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