Abstract
Background: Since the first aortic valve replacement through a right thoracotomy was reported in 1993, upper hemisternotomy and right anterior thoracotomy have become the predominant approaches for minimally invasive aortic valve replacement. Clinical studies have documented equivalent operative mortality, less bleeding, and reduced intensive care/hospital stay compared with conventional sternotomy despite longer procedure times. However, comparative trials face challenges due to patient preference, surgeon bias, and the lack of a standardized minimally invasive surgical approach. Methods: Twenty cardiothoracic surgeons from 19 institutions across the United States, with a combined experience of nearly 5000 minimally invasive aortic valve replacement operations, formed a working group to develop a basis for a standardized approach to patient evaluation, operative technique, and postoperative care. In addition, a stepwise learning program for surgeons was outlined. Results: Improved cosmesis, less pain and narcotic use, and faster recovery have been reported and generally accepted by patients and by surgeons performing minimally invasive aortic valve replacement. These benefits are more likely to be verified with standardization of the procedure itself, which will greatly facilitate the design and implementation of future clinical studies. Conclusions: Surgeons interested in learning and performing minimally invasive aortic valve replacement must have expertise in conventional aortic valve replacement at centers with adequate case volumes. A team approach that coordinates efforts of the surgeon, anesthesiologist, perfusionist, and nurses is required to achieve the best clinical outcomes. By first developing fundamental minimally invasive skills using specialized cannulation techniques, neck lines, and long-shafted instruments in the setting of conventional full sternotomy, the safest operative environment is afforded to patients.
Original language | English (US) |
---|---|
Pages (from-to) | 6-14 |
Number of pages | 9 |
Journal | Journal of Thoracic and Cardiovascular Surgery |
Volume | 147 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2014 |
Funding
Disclosures: Edwards Lifesciences provided reasonable travel, lodging, and honorarium for participation by many of the authors in a medical advisory board meeting where, as one of the agenda topics, initial concepts for the minimally invasive aortic valve replacement manuscript were validated. Authors were not compensated for any time spent writing or reviewing this manuscript and claim full responsibility for the integrity of this work. S. Chris Malaisrie reports lecture fees from Edwards Lifesciences and Medtronic. Glenn R. Barnhart reports consulting fees from Edwards, and lecture fees from Edwards and Atricure. R. Saeid Farivar reports consulting fees from Edwards. John Mehall reports consulting fees from Edwards. Brian Hummel reports consulting fees from Edwards, St. Jude, and Estech. Evelio Rodriguez reports consulting fees from Cardionet, Edwards, and Atricure and lecture fees and grant support from Medtronic. Mark Anderson reports consulting fees from Abiomed and Edwards. Clifton Lewis reports consulting fees from Edwards. Clark Hargrove reports consulting fees from Edwards and Sorin. Gorav Ailawadi reports consulting fees from Edwards, Atricure, Mitralign, and Abbott and lecture fees from St. Jude. Scott Goldman reports consulting fees from Edwards, St. Jude, and LSI. Junaid Khan reports consulting and lecture fees from Edwards. Michael Moront reports consulting fees from Edwards, Medtronic, and Terumo and lecture fees from Medtronic. Eugene Grossi reports consulting fees from Edwards and Medtronic. Eric E. Roselli reports consulting fees from Edwards and Medtronic. Arvind Agnihotri reports consulting fees from Edwards and lecture fees from Intuitive Surgical. Michael J. Mack reports consulting fees from Edwards. J. Michael Smith reports consulting fees from Atricure. Vinod H. Thourani reports consulting fees from Edwards. Francis G. Duhay is a full-time employee of Edwards Lifesciences. Mark T. Kocis is a full-time employee of Edwards Lifesciences. William H. Ryan reports consulting fees from Edwards and Medtronic.
ASJC Scopus subject areas
- Surgery
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine