title: Perioperative Outcomes of Minimally Invasive Aortic Valve Replacement through Right Anterior Minithoracotomy.
abstract: Background The aim of the study was to analyze perioperative outcomes after minimally invasive aortic valve replacement through right anterior minithoracotomy (RAT-AVR). Patient selection criteria, anesthesia protocol, and surgical technique are presented. Methods A retrospective analysis of 194 patients electively scheduled for RAT-AVR was performed between January 2009 and June 2013. For preoperative planning, computed tomography was performed. Results Among studied patients, there were 48.5% females and 51.5% males with a mean age of 69.9 ± 9.2 years. The predicted mortality calculated with EuroSCORE II was 3.2 ± 0.9%, and observed mortality of RAT-AVR patients was 1.5%. Finally, RAT-AVR surgery was performed on 97.9% of patients (n = 190). Reasons for conversions to median sternotomy were bleeding from aortotomy site (n = 4) and from the right ventricle after epicardial pacing wire placement (n = 1), pleural adhesions (n = 2), and ascending aorta hidden under the sternum (n = 2). The second intercostal space was chosen for surgical access in 97.9% of patients.There were 3.6% reoperations for bleeding: aortotomy place (n = 1), epicardial pacing wire placement (n = 3), right lung tear (n = 2), and intercostal vessels (n = 1). The intensive care unit and hospital length of stays were 1.3 ± 1.2 and 5.7 ± 1.4 days, respectively. Strokes were present in 1.5% of patients. The perioperative complications rate diminished with time, occurring in 44.9% of the patients between 2009 and 2010 and in 15.6% of patients in 2013. Conclusions RAT-AVR can be safely performed without increased morbidity and mortality. Reduced complication rates over time reflect a learning curve.
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Stoliński
authors.affiliation: Department of Statistics, Cracow University of Economics, Cracow, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Plicner
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Grudzień
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Kruszec
authors.affiliation: Department of Anesthesiology and Intensive Therapy, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Musiał
authors.affiliation: Department of Anesthesiology and Intensive Therapy, John Paul II Hospital, Jagiellonian University of Cracow, Cracow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Andres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002983:Clinical Competence; D061887:Conversion to Open Surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome