An innovative minimally invasive technique for aortic valve replacement

Minimally invasive aortic valve replacement (MIAVR) by right mini-thoracotomy is used by some centres as an alternative to conventional full sternotomy. Whether this technique may replace full sternotomy and become the routine approach for aortic valve replacement remains an open question. The surgical technique, complication rates, learning curve, and patient outcomes collected during a 4-year experience by three centres were reviewed to answer this question. We retrospectively analysed the results obtained in 354 patients (212 males, 59.9%) who, between January 2010 and July 2014, underwent MIAVR through a right mini-thoracotomy in three centres [Maria Cecilia H (Cotignola), Villa Torri H (Bologna), and ICLAS (Rapallo)] belonging to the same medical organisation (GVM Care and Research). Patients' mean age was 72.2 +/- 11.8 years (range 16-93) and mean EuroSCORE was 6.3 +/- 2.3. Aortic valve replacement was performed through a 4- to 6-cm skin incision at the third intercostal space; 332 patients (93.8%) received a bioprosthesis and only 22 patients a mechanical valve. Overall, the cardiopulmonary bypass took 74.6 +/- 28.5 min and aortic cross-clamping 59.8 +/- 23.6 min. Mean intensive care length of stay and hospital stay was 58.4 +/- 101.3 h (median 41 h) and 11.4 +/- 7.3 days (median 9 days), respectively. In-hospital mortality was 0.8% (3/354). Our initial series confirms that MIAVR through a right mini-thoracotomy is a safe procedure that provides excellent results. Cardiopulmonary bypass, aortic cross-clamp and skin-to-skin times were comparable with those used for standard full sternotomy. Central cannulation can be easily performed without increasing surgical time and avoiding groin incisions. In our experience, this technique allows early mobilization and rehabilitation, as well as providing excellent aesthetic results and lower risks of wound complications. We thus believe that MIAVR could become the new standard approach.