title: Aortic valve replacement through right minithoracotomy: is it really biologically minimally invasive?
abstract: BACKGROUND
  Minimally invasive aortic valve replacement through a right mini-thoracotomy is a procedure developed in the past few years. Currently, the main limits of this technique are longer cardiopulmonary bypass time compared with the standard approach and the need for peripheral cannulation.
  
  
  METHODS
  From January 2010 to March 2014, 206 patients underwent an aortic valve replacement using a minimally invasive technique through a right mini-thoracotomy. Mean age was 71.4 ± 12.0 years, and 129 (62.6%) were male. In the first series of 42 patients, the vacuum-assisted venous drainage was obtained percutaneously through the groin. A totally central arterial and venous cannulation was adopted in the subsequent 164 patients. Two hundred patients (97.1%) received a bioprosthesis implanted with three 2-0 Prolene running sutures; a mechanical valve was implanted in six patients. One patient required reoperation.
  
  
  RESULTS
  Aortic valve replacement was performed through a 4-6-cm skin incision at the third intercostal space. Overall cardiopulmonary bypass was 64.8 ± 17.2 min, and aortic cross clamping was 51.8 ± 14.9 min. In-hospital mortality was 1.5% (3/206).
  
  
  CONCLUSIONS
  Our initial series confirms that aortic valve replacement performed through a right mini-thoracotomy is a safe procedure. When using running sutures, it is possible to obtain cardiopulmonary bypass and cross-clamping times comparable to those for the standard approach. A central cannulation can be performed easily to avoid groin incisions. In conclusion, we believe that this kind of surgery could really be a biologically minimally invasive approach, rather than just an aesthetic choice.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care and Research, Cotignola, ES Health Science Foundation, Cotignola, Italy. Electronic address: elisamikus@yahoo.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: Mikus
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Villa Torri Hospital, GVM Care and Research, Bologna, ES Health Science Foundation, Cotignola, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Turci
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care and Research, Cotignola, ES Health Science Foundation, Cotignola, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Calvi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Villa Torri Hospital, GVM Care and Research, Bologna, ES Health Science Foundation, Cotignola, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Ricci
authors.affiliation: ES Health Science Foundation, Cotignola, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Dozza
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Maria Cecilia Hospital, GVM Care and Research, Cotignola, ES Health Science Foundation, Cotignola, Italy; Department of Cardiothoracic and Vascular Surgery, Villa Torri Hospital, GVM Care and Research, Bologna, ES Health Science Foundation, Cotignola, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Del Giglio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*; D055815:Young Adult