Minimally Invasive Aortic Valve Replacement (Mini-AVR) is Peripheral Cannulation Mandatory?

Shlomo Yaron Ishay Cardiothoracic Surgery Department, Soroka Medical Univestity Center, Beer Sheva, Beer Sheva, Israel Oren Lev - Ran Cardiothoracic Surgery Department, Soroka Medical Univestity Center, Beer Sheva, Beer Sheva, Israel Menachem Matsa Cardiothoracic Surgery Department, Soroka Medical Univestity Center, Beer Sheva, Beer Sheva, Israel Mahmud Abu Salah Cardiothoracic Surgery Department, Soroka Medical Univestity Center, Beer Sheva, Beer Sheva, Israel Leonid Ruderman Cardiothoracic Surgery Department, Soroka Medical Univestity Center, Beer Sheva, Beer Sheva, Israel Dan Abrhamov Cardiothoracic Surgery Department, Soroka Medical Univestity Center, Beer Sheva, Beer Sheva, Israel Gideon Sahar Cardiothoracic Surgery Department, Soroka Medical Univestity Center, Beer Sheva, Beer Sheva, Israel

Background: Minimally invasive aortic valve replacement (mini-AVR) is becoming the preferred approach for isolated aortic valve surgeries. The outcomes are equivalent to conventional AVR with decrease blood loss, potential for less pain, quicker recovery and enhance and enhance cosmetics results. While femoral cannulation is still the most frequently used form, it is more time and resources consuming, can lead to groin complications especially in obese patients and eventually requires additional incision.

This study details the approach to the minimally invasive AVR without standard femoral cannulation and points out our preliminary clinical experience.

Results: From February to December 2017, Isolated Aortic valve surgeries were performed through a partial upper hemisternotomy in 12 patients. 6 (50%) were females, mean age 60±10y, average and median BMI (body mass index) was 29 (22-48). Mean STS score was 2.3±1.8

No conversion to median sternotomy was required. Mean aortic cross-clamp time was 80±25 minutes. Mean bypass time was 99±30 minutes. Mean 24 hours postoperative bleeding was 157 ml. (range 70-225 ml). Mean mechanical ventilation time was 7.4hours (range 3-11h). The incidence reexploration for bleeding and sternal wound infection or dehiscence was 0.

One patient died 14 days after operation due to malignant arrhythmia.

Conclusions: Mini-AVR surgery using central cannulation is a safe, reproducible and effective procedure especially in obese patients. Mini-AVR using central cannulation should be considered as an alternative surgical to reduce obesity related complication.

Presentation

Shlomo Yaron Ishay

ישי

Soroka medical Center