title: Should minimally invasive aortic valve replacement be restricted to primary interventions?
abstract: BACKGROUND
  The role of minimally invasive aortic valve replacement in cardiac reoperations has not yet been defined. The purpose of this study is to report our experience with this technique.
  
  
  METHODS
  Nineteen consecutive patients underwent aortic valve replacement via J-sternotomy as a reoperative cardiac procedure between 1999 and 2005. The mean age was 73.6 +/- 11.4 years. Previous cardiac operations included 12 (63.2 %) coronary artery bypass graftings, 6 (31.5 %) aortic valve replacements and 1 (5.2 %) mitral valve replacement. Mean follow-up was 23.6 +/- 19.7 months. The medical records were retrospectively analyzed.
  
  
  RESULTS
  All procedures were successful. Mean aortic cross-clamping time and cardiopulmonary bypass time were 87.4 +/- 32.7 and 133.1 +/- 54.4 minutes, respectively. Cannulation sites were: ascending aorta (52.6 %), femoral artery (47.4 %), femoral vein (94.8 %) and right atrium (5.2 %). Myocardial protection was obtained by selective coronary osteal cold crystalloid cardioplegia and systemic cooling (mean 26.2 +/- 4 degrees C). Average intubation time was 1.5 +/- 1.4 days. Mean intensive care unit stay and postoperative hospital stay was 2.9 +/- 2.6 and 12.9 +/- 5.7 days, respectively. Median chest tube output was 550 ml. There were 4 revisions for bleeding. There were 2 late deaths and one non-incision related hospital death (5 %). This patient, who was already being treated for chronic dialysis, died on day 22 due to a cerebrovascular accident.
  
  
  CONCLUSIONS
  Minimally invasive aortic valve replacement is feasible as a reoperative procedure. Its major advantage is avoidance of cardiac reexposure with potential damage to coronary grafts. We think this technique deserves more widespread application.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, OLV Clinic, Aalst, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Bakir
authors.forename: F P
authors.initials: FP
authors.lastname: Casselman
authors.forename: R
authors.initials: R
authors.lastname: De Geest
authors.forename: F
authors.initials: F
authors.lastname: Wellens
authors.forename: I
authors.initials: I
authors.lastname: Degrieck
authors.forename: F
authors.initials: F
authors.lastname: Van Praet
authors.forename: Y
authors.initials: Y
authors.lastname: Vermeulen
authors.forename: H
authors.initials: H
authors.lastname: Vanermen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012086:Reoperation; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery