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Eur J Cardiothorac Surg 1999;15:32-38
© 1999 Elsevier Science NL

Minimal access aortic valve surgery ¹

Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, S-581 85 Linköping, Sweden

^* Corresponding author. Tel.: +46-13-224-800; fax: +46-13-100-246; e-mail: christian.olin@thx.us.lio.se

Objective: We report our experience with minimal access aortic valve surgery and discuss the three approaches used. Methods: From June 1996 to October 1997, 18 patients underwent minimally invasive aortic valve surgery through three different incisions: right parasternal minithoracotomy (three cases), upper ministernotomy (11 cases), and transverse sternotomy (four cases). No special surgical instrumentation was used. Aortic valve replacement was carried out in 17 patients and aortic valve repair in one patient. The patients ranged in age from 42 to 86 years (mean 64 years). Concomitant procedures involving the aortic root and the ascending aorta were performed in five patients. Results: There was no mortality and no complications related to the procedure or the access. There was no instability or paradoxical movement of the chest wall. One patient was reoperated for postoperative bleeding. All patients were discharged from hospital within the usual time. No attempts were made to discharge them earlier, even if they recovered quickly. Conclusions: Of the three incisions used, the upper ministernotomy seemed to be the safest and easiest to perform. Through this incision, both the aorta and the right atrium could be cannulated, the right ventricle was accessible, and concomitant procedures on the ascending aorta could be carried out. The drawback of minimal access aortic valve surgery in general is that it is difficult to de-air the heart and more difficult to master intra- and postoperative complications should they occur.

Key Words: Cardiac surgery • Aortic valve surgery • Minimally invasive cardiac surgery