Sutureless Aortic Valve Replacement Through Lateral Mini-Thoracotomy　― Feasibility and Effectiveness

• Published in: Circulation Journal 2022/10/25, Vol.86(11), pp.1733-1739
• Main Authors: Nakamura, Yoshitsugu, Narita, Takuya, Kuroda, Miho, Nakayama, Taisuke, Tsuruta, Ryo, Yoshiyama, Daiki, Yasumoto, Yuto, Sawa, Shintaro, Furutachi, Akira, Ito, Yujiro
• Format: Article
• Language: English
• Subjects: Aortic stenosis; Aortic Valve - surgery; Aortic valve replacement; Aortic Valve Stenosis - surgery; Feasibility Studies; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Humans; Minimally invasive; Minimally Invasive Surgical Procedures - methods; Perceval; Retrospective Studies; Sutureless valve; Thoracotomy - adverse effects; Thoracotomy - methods; Treatment Outcome
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-22-0282

Background: Minimally invasive sutureless aortic valve replacement with the Perceval bioprosthetic heart valve (MISUAVR) is commonly performed through a right anterior thoracotomy (AT). However, a lateral thoracotomy (LT) may be superior as it does not require rib and right internal thoracic artery (RITA) cutting.Methods and Results: In total, 38 MISUAVRs performed from May 2019 to approximately August 2021 were retrospectively reviewed; 21 through LT (Group L), and 17 through AT (Group A). In Group L, the skin incision was made on the right anterior axillary line and third intercostal space, and in group A, on the right anterior chest and second or third intercostal space. All other surgical techniques were the same. Age, body surface area, EuroSCORE II, and ejection fraction were similar between the patients. Cardiopulmonary bypass (L: 82±19 vs. A: 93±28 min, P=0.19) and cross-clamp times (L: 57±13, vs. A: 64±23 min, P=0.19) were similar. Rib and/or RITA cutting were required in 94.6% of patients in group A and in none of group L (P