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. 2023 Jun 1;36(6):ivad101.
doi: 10.1093/icvts/ivad101.

Endoscopic aortic valve surgery in isolated and concomitant procedures

Daniele Zoni  1 , Giovanni Domenico Cresce  1 , Tommaso Hinna-Danesi  1 , Luciana Benvegnù  1 , Salvatore Poddi  1 , Michele Gallo  2 , Massimo Sella  1 , Loris Salvador  1
Affiliations

Endoscopic aortic valve surgery in isolated and concomitant procedures

Daniele Zoni et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: To evaluate early outcomes of endoscopic aortic valve replacement (AVR) and risks of concomitant procedures done through the same working port.

Methods: At our institution, we performed a data analysis of 342 consecutive patients (from July 2013 to May 2021) who underwent endoscopic AVR with or without associated major procedure. Preoperative, intraoperative, postoperative data were evaluated. Subsequently, we perform a comparative analysis between the isolated and concomitant surgery group. The surgical access was a 3- to 4-cm working port in the second right intercostal space and 3 additional 5-mm mini-ports for the introduction of the thoracoscope, the transthoracic clamp and the vent line. Cardiopulmonary by-pass was achieved through peripheral cannulation.

Results: 105 patients (30.7%) underwent combined procedure: 2 coronary artery bypass (1.9%), 21 ascending aorta replacement (19.6%), 41 mitral surgery (38.3%), 16 mitral and tricuspid surgery (15%) and 25 other procedure (27%). Death occurred in 1 patient (0.4%) in the isolated group versus 2 patients (1.9%) in the combined group (P = 0.175). Seven strokes were observed, 4 in isolated procedures (1.7%) and 3 in the concomitant ones (2.85%) (P = 0.481). Surgical revision for bleeding was performed always through the same access in 13 patients (5.4%) versus 11 patients (10.4%) (P = 0.096). Pacemaker implantation was necessary in 5 patients (2.1%) versus 8 patients (7.6%) (P = 0.014). Median intubation time was 5 (2) h vs 6 (8) (P < 0.080).

Conclusions: Through a single working port made for endoscopic AVR, a concomitant procedure may be done without affecting in-hospital mortality and postoperative stroke rate.

Keywords: Aortic valve disease; Combined endoscopic cardiac procedures; Endoscopic aortic valve replacement; Endoscopic cardiac surgery; Mortality in endoscopic cardiac surgery; Stroke in endoscopic cardiac surgery.

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Figures

Figure 1:
Figure 1:
(A) Schematic view of the operative field and the working port. (B) Rapid deployment valve. (C) Mitral valve repair. (D) Tricuspid valve repair. (E) Wound dimension at the end of surgery.
Figure 2:
Figure 2:
Concomitant endoscopic aortic valve and ascending aorta replacement: operative view and thoracoscopic vision (box).
None
See this image and copyright information in PMC

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