Loading…
Right Anterior Minithoracotomy for Aortic Valve Replacement: A Widely Applicable, Simple, and Stepwise Approach
Objective A stepwise approach for right anterior minithoracotomy aortic valve replacement (RAT-AVR), without sutureless valves, special instruments, or preoperative imaging, was developed. We report our experience with this widely applicable, simplified approach. Methods Patients with a history of p...
Saved in:
| Published in: | Innovations (Philadelphia, Pa.) Pa.), 2019-08, Vol.14 (4), p.321-329 |
|---|---|
| Main Authors: | , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c337t-d513a9ae4318485b0a8cf97ecb83faef2e2e9d57694336d0503ec6c916d06143 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c337t-d513a9ae4318485b0a8cf97ecb83faef2e2e9d57694336d0503ec6c916d06143 |
| container_end_page | 329 |
| container_issue | 4 |
| container_start_page | 321 |
| container_title | Innovations (Philadelphia, Pa.) |
| container_volume | 14 |
| creator | Ribeiro, Igo B. Ruel, Marc |
| description | Objective
A stepwise approach for right anterior minithoracotomy aortic valve replacement (RAT-AVR), without sutureless valves, special instruments, or preoperative imaging, was developed. We report our experience with this widely applicable, simplified approach.
Methods
Patients with a history of previous chest surgery, documented PVD, severe COPD, LVOT size |
| doi_str_mv | 10.1177/1556984519844745 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2232008165</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_1556984519844745</sage_id><sourcerecordid>2232008165</sourcerecordid><originalsourceid>FETCH-LOGICAL-c337t-d513a9ae4318485b0a8cf97ecb83faef2e2e9d57694336d0503ec6c916d06143</originalsourceid><addsrcrecordid>eNp1kElPwzAQhS0EYr9zQj5yIGDHSxJuUcUmFSG1CI6R60yoqyQOtgvqv8elwAGJy8xo5nvP8kPohJILSrPskgohi5wLGgvPuNhC-3FVJCTPiu2vWSbr-x468H5BCGeS8120xyiJAi73kZ2Y13nAZR_AGevwg-lNmFuntA22W-Em7krrgtH4WbXvgCcwtEpDB324wiV-MTW0K1wOQ2u0mrVwjqemG9Zd9TWeBhg-jIc14KzS8yO006jWw_F3P0RPN9dPo7tk_Hh7PyrHiWYsC0ktKFOFAs5oznMxIyrXTZGBnuWsUdCkkEJRi0wWnDFZE0EYaKkLGmdJOTtEZxvb-OrbEnyoOuM1tK3qwS59laYsJSSnUkSUbFDtrPcOmmpwplNuVVFSrVOu_qYcJaff7stZB_Wv4CfWCCQbwKtXqBZ26fr42f8NPwFH54SW</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2232008165</pqid></control><display><type>article</type><title>Right Anterior Minithoracotomy for Aortic Valve Replacement: A Widely Applicable, Simple, and Stepwise Approach</title><source>Sage Journals Online</source><creator>Ribeiro, Igo B. ; Ruel, Marc</creator><creatorcontrib>Ribeiro, Igo B. ; Ruel, Marc</creatorcontrib><description>Objective
A stepwise approach for right anterior minithoracotomy aortic valve replacement (RAT-AVR), without sutureless valves, special instruments, or preoperative imaging, was developed. We report our experience with this widely applicable, simplified approach.
Methods
Patients with a history of previous chest surgery, documented PVD, severe COPD, LVOT size <2.0 cm, and root size <2.8 cm were excluded. Chest CT was not mandatory. The stepwise surgical approach consists of 1) tolerability of single-lung ventilation; 2) 5-cm long incision on third right anterior ICS; 3) small pericardial opening to localize the aortic valve annular plane by digital palpation; 4) shingling of the correct rib to create a box field; 5) optimizing exposure with stay sutures; 6) femoral or central cannulation with right superior pulmonary vein venting and usual antegrade cardioplegia; 7) performing a standard AVR without adjunct instruments; and 8) reconstructing 1 costochondral cartilage.
Results
Fifty-five patients were operated. The mean age was 68.5 years (SD 10.4); 29.1% were female. Median STS PROM was 1.18 (0.4 to 6.6). Pump and cross-clamp times were 104.8 minutes (SD 27.9) and 73.2 minutes (SD 22.8), respectively. There was no need for a knot pusher. There was 1 conversion, 1 reopening for bleeding, and 1 pacemaker insertion. No patient had a stroke, MI, or death at 30 days. The median LOS was 6 days (3 to 19).
Conclusion
RAT-AVR can be applicable and performed safely in a wide range of patients by adopting a simple, stepwise approach with intraoperative assessment, without the need for special imaging, instrumentation, or advanced training.</description><identifier>ISSN: 1556-9845</identifier><identifier>EISSN: 1559-0879</identifier><identifier>DOI: 10.1177/1556984519844745</identifier><identifier>PMID: 31084446</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Aortic Valve Stenosis - surgery ; Female ; Heart Valve Prosthesis Implantation - methods ; Humans ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; One-Lung Ventilation ; Postoperative Complications - epidemiology ; Thoracotomy - methods</subject><ispartof>Innovations (Philadelphia, Pa.), 2019-08, Vol.14 (4), p.321-329</ispartof><rights>The Author(s) 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-d513a9ae4318485b0a8cf97ecb83faef2e2e9d57694336d0503ec6c916d06143</citedby><cites>FETCH-LOGICAL-c337t-d513a9ae4318485b0a8cf97ecb83faef2e2e9d57694336d0503ec6c916d06143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,79364</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31084446$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ribeiro, Igo B.</creatorcontrib><creatorcontrib>Ruel, Marc</creatorcontrib><title>Right Anterior Minithoracotomy for Aortic Valve Replacement: A Widely Applicable, Simple, and Stepwise Approach</title><title>Innovations (Philadelphia, Pa.)</title><addtitle>Innovations (Phila)</addtitle><description>Objective
A stepwise approach for right anterior minithoracotomy aortic valve replacement (RAT-AVR), without sutureless valves, special instruments, or preoperative imaging, was developed. We report our experience with this widely applicable, simplified approach.
Methods
Patients with a history of previous chest surgery, documented PVD, severe COPD, LVOT size <2.0 cm, and root size <2.8 cm were excluded. Chest CT was not mandatory. The stepwise surgical approach consists of 1) tolerability of single-lung ventilation; 2) 5-cm long incision on third right anterior ICS; 3) small pericardial opening to localize the aortic valve annular plane by digital palpation; 4) shingling of the correct rib to create a box field; 5) optimizing exposure with stay sutures; 6) femoral or central cannulation with right superior pulmonary vein venting and usual antegrade cardioplegia; 7) performing a standard AVR without adjunct instruments; and 8) reconstructing 1 costochondral cartilage.
Results
Fifty-five patients were operated. The mean age was 68.5 years (SD 10.4); 29.1% were female. Median STS PROM was 1.18 (0.4 to 6.6). Pump and cross-clamp times were 104.8 minutes (SD 27.9) and 73.2 minutes (SD 22.8), respectively. There was no need for a knot pusher. There was 1 conversion, 1 reopening for bleeding, and 1 pacemaker insertion. No patient had a stroke, MI, or death at 30 days. The median LOS was 6 days (3 to 19).
Conclusion
RAT-AVR can be applicable and performed safely in a wide range of patients by adopting a simple, stepwise approach with intraoperative assessment, without the need for special imaging, instrumentation, or advanced training.</description><subject>Aged</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Female</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>One-Lung Ventilation</subject><subject>Postoperative Complications - epidemiology</subject><subject>Thoracotomy - methods</subject><issn>1556-9845</issn><issn>1559-0879</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kElPwzAQhS0EYr9zQj5yIGDHSxJuUcUmFSG1CI6R60yoqyQOtgvqv8elwAGJy8xo5nvP8kPohJILSrPskgohi5wLGgvPuNhC-3FVJCTPiu2vWSbr-x468H5BCGeS8120xyiJAi73kZ2Y13nAZR_AGevwg-lNmFuntA22W-Em7krrgtH4WbXvgCcwtEpDB324wiV-MTW0K1wOQ2u0mrVwjqemG9Zd9TWeBhg-jIc14KzS8yO006jWw_F3P0RPN9dPo7tk_Hh7PyrHiWYsC0ktKFOFAs5oznMxIyrXTZGBnuWsUdCkkEJRi0wWnDFZE0EYaKkLGmdJOTtEZxvb-OrbEnyoOuM1tK3qwS59laYsJSSnUkSUbFDtrPcOmmpwplNuVVFSrVOu_qYcJaff7stZB_Wv4CfWCCQbwKtXqBZ26fr42f8NPwFH54SW</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Ribeiro, Igo B.</creator><creator>Ruel, Marc</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201908</creationdate><title>Right Anterior Minithoracotomy for Aortic Valve Replacement: A Widely Applicable, Simple, and Stepwise Approach</title><author>Ribeiro, Igo B. ; Ruel, Marc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-d513a9ae4318485b0a8cf97ecb83faef2e2e9d57694336d0503ec6c916d06143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Female</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>One-Lung Ventilation</topic><topic>Postoperative Complications - epidemiology</topic><topic>Thoracotomy - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ribeiro, Igo B.</creatorcontrib><creatorcontrib>Ruel, Marc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Innovations (Philadelphia, Pa.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ribeiro, Igo B.</au><au>Ruel, Marc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Right Anterior Minithoracotomy for Aortic Valve Replacement: A Widely Applicable, Simple, and Stepwise Approach</atitle><jtitle>Innovations (Philadelphia, Pa.)</jtitle><addtitle>Innovations (Phila)</addtitle><date>2019-08</date><risdate>2019</risdate><volume>14</volume><issue>4</issue><spage>321</spage><epage>329</epage><pages>321-329</pages><issn>1556-9845</issn><eissn>1559-0879</eissn><abstract>Objective
A stepwise approach for right anterior minithoracotomy aortic valve replacement (RAT-AVR), without sutureless valves, special instruments, or preoperative imaging, was developed. We report our experience with this widely applicable, simplified approach.
Methods
Patients with a history of previous chest surgery, documented PVD, severe COPD, LVOT size <2.0 cm, and root size <2.8 cm were excluded. Chest CT was not mandatory. The stepwise surgical approach consists of 1) tolerability of single-lung ventilation; 2) 5-cm long incision on third right anterior ICS; 3) small pericardial opening to localize the aortic valve annular plane by digital palpation; 4) shingling of the correct rib to create a box field; 5) optimizing exposure with stay sutures; 6) femoral or central cannulation with right superior pulmonary vein venting and usual antegrade cardioplegia; 7) performing a standard AVR without adjunct instruments; and 8) reconstructing 1 costochondral cartilage.
Results
Fifty-five patients were operated. The mean age was 68.5 years (SD 10.4); 29.1% were female. Median STS PROM was 1.18 (0.4 to 6.6). Pump and cross-clamp times were 104.8 minutes (SD 27.9) and 73.2 minutes (SD 22.8), respectively. There was no need for a knot pusher. There was 1 conversion, 1 reopening for bleeding, and 1 pacemaker insertion. No patient had a stroke, MI, or death at 30 days. The median LOS was 6 days (3 to 19).
Conclusion
RAT-AVR can be applicable and performed safely in a wide range of patients by adopting a simple, stepwise approach with intraoperative assessment, without the need for special imaging, instrumentation, or advanced training.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>31084446</pmid><doi>10.1177/1556984519844745</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1556-9845 |
| ispartof | Innovations (Philadelphia, Pa.), 2019-08, Vol.14 (4), p.321-329 |
| issn | 1556-9845 1559-0879 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2232008165 |
| source | Sage Journals Online |
| subjects | Aged Aortic Valve Stenosis - surgery Female Heart Valve Prosthesis Implantation - methods Humans Length of Stay - statistics & numerical data Male Middle Aged One-Lung Ventilation Postoperative Complications - epidemiology Thoracotomy - methods |
| title | Right Anterior Minithoracotomy for Aortic Valve Replacement: A Widely Applicable, Simple, and Stepwise Approach |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T12%3A11%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Right%20Anterior%20Minithoracotomy%20for%20Aortic%20Valve%20Replacement:%20A%20Widely%20Applicable,%20Simple,%20and%20Stepwise%20Approach&rft.jtitle=Innovations%20(Philadelphia,%20Pa.)&rft.au=Ribeiro,%20Igo%20B.&rft.date=2019-08&rft.volume=14&rft.issue=4&rft.spage=321&rft.epage=329&rft.pages=321-329&rft.issn=1556-9845&rft.eissn=1559-0879&rft_id=info:doi/10.1177/1556984519844745&rft_dat=%3Cproquest_cross%3E2232008165%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c337t-d513a9ae4318485b0a8cf97ecb83faef2e2e9d57694336d0503ec6c916d06143%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2232008165&rft_id=info:pmid/31084446&rft_sage_id=10.1177_1556984519844745&rfr_iscdi=true |