I would like to have a Right Minithoracotomy

for my Aortic ValveHow it should be done

Glauber Mattia

1

Presenter disclosure information

Dr Glauber disclose a financial relationship for

educational program with Sorin Group.

Dr Glauber is Principal Investigator of Fundation Study

sponsored by Edwards and is part of Medtronic Advisory

Board.

1. Right Anterior Minithoracotomy 92%

2. Ministernotomy 8%

MIAVR Surgical Access in 593 Pts

CT evaluation: anatomical complexity

Complexity is lower if at the level of PA bifurcation:

Rule 1. Aorta is rightward (>50% aorta from right sternal)Rule 2. The distance from ascending aorta to sternum < 10 cm

α

Angle α ≥45°

CT evaluation: anatomical complexity

Exclusion criteria:

• Severe enphisema and COPD• Need for ascending aortic surgery• Redo’s with bioprosthetic valve replacement

Conversion to full sternotomy

Causes n/N (%)

unexpected right pleural cavity adhesions 2/13, 15.4%

technical impossibility to advance the percutaneous venous cannula

2/13, 15.4%

bleeding 5/13, 38.5%

arterial hypotension with haemodynamic instability 1/13, 7.7%

difficult weaning from CPB 1/13, 7.7%

perivalvular leak 2/13, 15.4%

13 patients (0.2%) out 593 needed conversion to full sternotomy

Results

Variable

Overall population

(n=593)

Isolated AVR

(n=541)

Isolated AVR with sutured prostheses

(n=258)

Isolated AVR with sutureless

prostheses (n=283)

Δ

CPB time

min

 107

(86-135)

 104

(84-129)

 121

(103.5-147.5)

 78

(77-107)

23%

X-clamp

time min

 74

(55-96)

 71

(54-92)

 87

(75-109)

 51

(37- 68)

37%

Operative times: overall data and comparison between subgroups

Results

Variable cohort (n=593)

ICU length of stay, days 1 (1-1)

Prolonged ICU stay ( > 1 day) 53 (8.9%)

Assisted ventilation time, <12h 6 (5-9)

Prolonged ventilation support ( > 12h) 22 (3.7%)

Hospital length of stay, days 6 (6-7)

In-hospital mortality 9 (1.5%)

Minimally invasive AVR is SAFE:

• low perioperative morbidity

• low rates of reoperation and death at late fup

Excellent outcomes can be achieved with minimally

invasive AVR through RAMT

Sutureless prostheses facilitate minimally invasive AVR

and are associated with reduced operative times

Conclusions

Thank You!