Trans-axillary Aortic Valve Replacement / 日本心臓血管外科学会雑誌

ABSTRACT

We have performed trans-axillary aortic valve replacement (TAX AVR) as a new minimally invasive approach in 5 patients with aortic regurgitation since September 2012. The mean age was 63 years (range 25-84 years). TAX AVR was performed through 7 cm skin incision along the right anterior axillary line, and small 4th intercostal thoracotomy. Cardiopulmonary bypass was established through the femoral artery and vein. Intra-thoracic procedures were performed under direct vision, or videoscopic assistance with the aid of minimally invasive surgical apparatus. The mean operative time was 312±44 min, cardiopulmonary bypass 217±38 min, and cross-clamp 139±22 min. The mean ventilation time was 4.2±6.1 h, and length of post-operative hospital stay was 14.8±0.9 days. There was no re-operation for bleeding, or conversion to median sternotomy. TAX AVR can avoid sternotomy, transection of rib, and sacrifice of internal thoracic artery. The postoperative wound was unrecognizable unless the right arm was raised. This approach may promise patients' early rehabilitation and better cosmetic results.