title: Aortic valve replacement using a stentless bioprosthesis through right minithoracotomy: an initial experience.
abstract: OBJECTIVE
  Aortic valve replacement (AVR) is nowadays a safe procedure with low rates of mortality and morbidity, but the necessity for a less invasive approach is going to increase. The use of a stentless prosthesis through right mini-thoracotomy has not yet been described and our experience could be useful for other surgeons.
  
  
  METHODS
  From June 2009 until March 2010, seven female patients (mean age 79.9 ± 5.7 years) underwent stentless-AVR for aortic stenosis through a right mini-thoracotomy (RM). The logistic Euroscore was 11.3 ± 6.1, and left ventricular ejection fraction was 60.7 ± 4.5%. In five cases RM was performed through the second intercostal space (ICS); in two cases through the third ICS. The cannulation was in most cases between ascending aorta and femoral vein (5/7). When transverse sternotomy was required (two patients), the right mammary artery was clipped and cut.
  
  
  RESULTS
  Extracorporeal circulation time (ECC) was 110 ± 41min and aortic cross clamp was 80 ± 35min. Two patients required transverse sternotomy. The mean bleeding was 484 ± 469ml and the duration of mechanical ventilation was 22.0 ± 12.5h. The ICU stay was 3.3 ± 2.2 days. No in-hospital death was observed. The mean hospital stay was 11.6 ± 5.4 days.
  
  
  CONCLUSIONS
  Right mini-thoracotomy is a safe and applicable approach even in case of AVR using stentless prosthesis. The risk of insufficient surgical exposure or complication may be safely managed, by enlarging the thoracotomy through transverse sternotomy. However, valve implantation could be more difficult than the standard approach and it requires an expert and confident surgeon with a large experience in standard stentless implantation.
authors.affiliation: Division of Cardiac Surgery, Mauriziano Umberto I Hospital, L.go Turati 62, 10135 Turin, Italy. fabrisans@katamail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sansone
authors.forename: Edoardo
authors.initials: E
authors.lastname: Zingarelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Punta
authors.forename: Roberto
authors.initials: R
authors.lastname: Flocco
authors.forename: Guglielmo Mario Actis
authors.initials: GM
authors.lastname: Dato
authors.forename: Pier Giuseppe
authors.initials: PG
authors.lastname: Forsennati
authors.forename: Francesco
authors.initials: F
authors.lastname: Parisi
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Bardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Ponte
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casabona
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D013908:Thoracotomy / Q000379:methods*