Aortic Valve Replacement Through a Mini Lateral Thoracotomy With High Thoracic Epidural Anesthesia

Background: Minimally invasive aortic valve surgery is usually performed through a right parasternal incision or a modification of partial sternotomy. We explored the feasibility of using a videoassisted small right lateral thoracotomy (RLT) to approach the aortic valve. Methods: From August 2003 to December 2004, 12 patients with aortic stenosis (9) or regurgitation (3) underwent an aortic valve replacement through an 8 cm RLT in the 4th intercostal space. There were 4 men and 8 women with a mean age of 61 years (range 30-79 years). Nine mechanical and 3 biologic prostheses were implanted. Endotracheal narcosis was combined with high thoracic epidural anesthesia. Transesophageal echocardiographic monitoring was performed in all cases. Cannulation was done via the right femoral artery and vein and right jugular vein. The video-assisted operation was performed in moderate hypothermia (30 degrees C) and in cardioplegic arrest. Transthoracic aortic clamping was used in all cases. Results: Mean operation, perfusion, and clamping times were 223 minutes, 132 minutes, and 73 minutes, respectively. There was no mortality. One patient required conversion to sternotomy due to discovery of a calcium fragment entrapped in a mechanical prosthesis. One patient developed a groin seroma that was treated surgically. All patients, except one were extubated in the operative room and transferred to the intermediate care unit after 6 hours; all had an uneventful recovery. Conclusions: Aortic valve replacement through an RLT is feasible and safe. Operative time, perfusion, and cross-clamping times are only marginally longer than a conventional operation, and recovery is rapid.