Minimally invasive aortic valve surgery

Abstract

Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.

Keywords: Aortic valve replacement; Aortic valve stenosis; Minimally invasive; Outcomes.

Figure 1.. Schematic drawing showing the skin incision required for the J mini-sternotomy into the right fourth or third intercostal space (A) and for the right anterior thoracotomy incision in the third intercostal space (B).

Figure 2.. View of the intraoperative field in a partial upper mini-sternotomy.

Figure 3.. Right anterior mini-toracotomy for AVR.

AVR: aortic valve replacement.