A totally endoscopic approach for aortic valve surgery

Abstract

OBJECTIVE A new approach for totally endoscopic aortic valve replacement is described. METHODS From October 2017 through December 2020, 266 consecutive patients underwent totally endoscopic aortic valve replacement. Reoperations and combinations were excluded. RESULTS A total of 266 patients with a median age of 72 [64, 79] years underwent totally endoscopic aortic valve replacement, of which 250 (93.98%) patients were indicated to undergo surgery because of aortic valve stenosis. The median follow-up index was 0.69 (0.30, 0.90). Major adverse cardiac and cerebrovascular events occurred in four (1.50%) patients within 30 days. Overall hospital mortality was 1.50%. Twenty additional deaths (7.52%) occurred during the three-year follow-up. An early thoracoscopic revision was needed in seven patients due to signs of bleeding or cardiac tamponade. Fourteen patients required permanent pacemaker implantation. CONCLUSIONS Retrospective analysis of our early experience with totally endoscopic aortic valve replacement in 266 consecutive patients demonstrated satisfactory results, with low mortality and acceptable morbidity rates.

Comparison of post-operative pain and quality of life between total thoracoscopic surgery and conventional full-sternotomy for aortic valve replacement

“…Moreover, TTS can provide a clear and magni ed view of the operative eld through a video camera, which may facilitate precise manipulation and suturing. [10] TTS also has some drawbacks and limitations. First, TTS requires a longer cardiopulmonary bypass time and aortic cross-clamp time than CFS, [11] which may increase the risk of ischemia-reperfusion injury and neurological complications.…”

Patient-Centred Outcomes after Totally Endoscopic Cardiac Surgery: One-Year Follow-Up

“…The description of the surgical techniques has been published before [ 2 , 6 ]. All procedures were performed using endoscopic ports (5 mm), a utility port (2–3 cm), and peripheral cardiopulmonary bypass (CPB).…”

“…Research in the field of cardiac surgery predominantly focuses on reducing surgical trauma and improving the post-operative complications [ 1 ]. Recently, new totally endoscopic techniques were developed including totally endoscopic aortic valve replacement (TEAVR), endoscopic coronary artery bypass grafting (Endo-CABG), and mitral valve surgery through video-assisted thoracoscopic surgery (MVATS) [ 2 , 3 , 4 , 5 , 6 ]. Besides endoscopic AVR, transcatheter aortic valve implantation (TAVI) through the femoral artery has gained popularity and may be a viable alternative [ 7 ].…”

Introductory Chapter: Heart Valve Surgery – Current Status and Future Directions

“…With the advent of transcatheter therapy and the obvious advantage of minimal to no incisions needed and the quick return to activities, this stimulated the surgical community to think of alternative accesses to aortic valve repair or replacement. A variety has been pioneered by several centers and expands from robotic [13], to totally endoscopic [14], to minimally invasive right axillary thoracotomy or anterior thoracotomy [15] and upper mini-sternotomy. While most data do not show major differences between upper sternotomy and right anterior mini-thoracotomy in terms of 30-day mortality [16], it is to be determined, the longer-term data of other minimally invasive approaches in comparison to standard sternotomy.…”