Outcome of mini aortic valve replacement via right parasternal mini-thoracotomy in patients with challenging anatomy
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Abstract
Objective: To describe the diagnostic features, surgical techniques, and outcomes of minimally invasive aortic valve replacement via right parasternal thoracotomy in patients with unfavorable anatomy.
Methods: This is a retrospective descriptive study including 34 patients indicated for aortic valve replacement, with non-rightward-deviated ascending aorta on CT scan, who underwent minimally invasive aortic valve replacement via a right parasternal second intercostal mini-thoracotomy at Hanoi Heart Hospital from September 2023 to September 2024.
Results: This retrospective descriptive study included 34 patients with a mean age of 63.3 years (range: 38–82 years). The mean aortic cross-clamp time, cardiopulmonary bypass time, and total operative time were 86 ± 27 minutes (range: 53–130 minutes), 130 ± 25 minutes (range: 80–170 minutes), and 215 ± 30 minutes (range: 155–250 minutes), respectively.The mean duration of postoperative mechanical ventilation was 18 ± 23.3 hours (range: 5–95 hours). The average length of stay in the intensive care unit (ICU) was 45 ± 42.5 hours (range: 30–170 hours), and the mean hospital length of stay was 10 ± 5 days (range: 5–15 days).There were no in-hospital mortalities and no conversions to full sternotomy. Postoperative complications included one case of re-exploration for chest wall bleeding (2.9%), one cerebrovascular accident (2.9%), two cases of pneumonia (5.8%), four cases of acute kidney injury (11.8%)—none of which required renal replacement therapy—one case of new-onset atrial fibrillation (2.9%), and one case of surgical site infection (2.9%). No other complications were recorded.
Conclusion: Minimally invasive aortic valve replacement via right parasternal second intercostal mini-thoracotomy in patients with unfavorable anatomy at Hanoi Heart Hospital is a safe, feasible, and effective option. This approach contributes to reducing mortality and cardiovascular complications, while offering several advantages over the conventional method.
Keywords
Aortic valve disease, minimally invasive aortic valve replacement, right parasternal second intercostal space, unfavorable anatomy
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References
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