Minimal Invasive Aortic Valve Replacement Through Right Mini_Thoracotomy Versus Conventional Approach In The Egypt

Abstract

Ahmed Mahmoud salama, Ahmed mohamed eid, Waleed adel, khaled mortada, Ahmed elsharkawy

Background: Full median sternotomy was established a long time ago as the standard approach for all varieties of heart surgery. Although that, it may cause significant surgical trauma and morbidity, so minimally invasive cardiac surgery for aortic valve replacement via partial sternotomy, para-sternal approach and anterior mini-thoracotomy is used trying to improve the outcome .
Objective: to check the outcome of minimally invasive aortic valve surgery through a right mini-thoracotomy, and its rule in minimizing the surgical access, achieving better wound appearance, decreasing post-operative discomfort and better postoperative recovery with the same safety and results like conventional surgery .
Methods: our study was performed in the Armed Forces Hospitals El Maddi& El Galaa and kobry elkobba, Egypt. Between January 2015 to March 2017, sixty patients were diagnosed with AVD requiring aortic valve surgery were randomly selected, of them Thirty patients had aortic valve surgery through full median sternotomy with aorto-right atrial cannulation and the other thirty patients had right mini-thoracotomy with femoral cannulation .
Results# Minimally invasive aortic valve replacement (MIAVR) was associated with reduced morbidity and mortality, where there was a safer approach in case of re-operation, better cosmetic outcome, less bleeding post-operative, lower number of blood products usage, less intensive care unit and hospital stays, decreased time until return to full activity and avoiding the incidence of sternal wound infection. That good results were also achievable in high-risk patients .
Conclusion: Minimal Invasive Aortic Valve Replacement Through Right Mini-thoracotomy is an acceptable alternative to Full median sternotomy, has reduced morbidity and potential mortality and good clinical outcome, with two concerns which are the operative cost and the relatively long bypass and cross clamp time which are related to the learning curve of the surgeons