title: Outcomes of aortic valve and concomitant ascending aorta replacement performed via a minimally invasive right thoracotomy approach.
abstract: OBJECTIVE
  Replacement of the aortic valve with concomitant replacement of the ascending aorta performed via a minimally invasive right anterior thoracotomy approach has not been reported. We evaluated the feasibility and safety of this procedure.
  
  
  METHODS
  We retrospectively reviewed all minimally invasive aortic valve replacements (AVRs) with concomitant replacement of the ascending aorta performed at our institution between January 1, 2012, and December 30, 2012. The operative times, intensive care unit and hospital lengths of stay, postoperative outcomes, as well as mortality were analyzed.
  
  
  RESULTS
  A total of 20 consecutive patients who underwent minimally invasive AVR with concomitant replacement of the ascending aorta were identified. There were 16 men (80%), with a mean (SD) age of 61 (13) years. The mean (SD) left ventricular ejection fraction was 58% (8%). The aortic valve was bicuspid in 18 patients (80%), with 14 (70%) being stenotic. The median aortic cross-clamp and cardiopulmonary bypass times were 163 [interquartile range (IQR), 141-170] minutes and 291 (IQR, 177-215) minutes, respectively. Hypothermic circulatory arrest was required in 19 patients (95%), with a median hypothermic circulatory arrest time of 35 (IQR, 33-39.5) minutes. The median intensive care unit and hospital lengths of stay were 24 (IQR, 23-41) hours and 5 (IQR, 4-6) days, respectively. There were no strokes, reoperations for bleeding, or conversions to sternotomy. The 30-day mortality was zero.
  
  
  CONCLUSIONS
  Minimally invasive AVR with concomitant replacement of the ascending aorta, via a right anterior thoracotomy approach, can be performed with low morbidity and mortality.
authors.affiliation: From the Divisions of *Cardiac Surgery, and †Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA.
authors.forename: Angelo
authors.initials: A
authors.lastname: LaPietra
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Pineda
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.forename: Joseph
authors.initials: J
authors.lastname: Lamelas
mesh_terms: D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002315:Cardiopulmonary Bypass; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D012189:Retrospective Studies; D013908:Thoracotomy