Minimally Invasive Approach (Para-sternum Small Incision) for Aortic Valve Replacement / 日本心臓血管外科学会雑誌

ABSTRACT

Minimally invasive surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function, especially in elderly patients. We began using a minimally invasive approach (small parasternal incision) for isolated aortic valve replacement (MICS AVR) from January 2011. Between January 2011 and February 2012, 32 patients underwent MICS AVR surgery. The mean age was 73 years (range 57-85 years) ; 69% were women. MICS AVR was performed through a skin incision of 6.5±0.5 cm along the third intercostal space. Cardiopulmonary bypass was established through the right femoral artery and vein. The patients were cooled to 28°C, the aorta was crossclamped with a flex clamp, and antegrade cardioplegic solution was given into the aortic root or selectively into the coronary ostia. The aortic valve procedure was performed in a standard fashion. If the distance to the aortic valve was too far, we used surgical instruments for minimally invasive surgery. Conversion to a conventional approach was not necessary in any patient. Mean overall operative time was 250±49 min, cardiopulmonary bypass 140±34 min, and crossclamp time 99±22 min. Mean ICU stay was 1.2±0.5 days and length of hospital stay was 10.3±2.2 days. There was no re-operation for bleeding or surgical site infection. MICS AVR was safe and feasible with excellent outcome. The advantages of this procedure include reduced bed rest, decreased postoperative pain, avoidance of deep sternal wound infection, and cosmetically attractive results. We now use the minimally invasive approach whenever possible. We report an early outcome, experience, strategy, and surgical technique.