Minimalist Surgical Aortic Valve Replacement

Jürg Grünenfelder, Sacha Salzberg, Thierry Aymard, Patric Biaggi, Silke Küest, David Huerlimann, Georg Noll, Ivano Reho, Christophe Wyss, Roberto Corti

Heart Clinic Hirslanden, Zürich, Switzerland

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – D

Abstract

Introduction

Surgical aortic valve replacement (SAVR) has been on the decline since the transcatheter aortic valve replacement (TAVR) became a valid alternative for the treatment of severe aortic valve stenosis. Therefore we evolved our existing minimal-invasive aortic valve replacement procedure to an even less (=minimalist) invasive SAVR program.

Methods

From 2014 to 2017 we operated 165 patients (mean age 69±7, EuroScore II 2.1) for aortic valve replacement through right minithoracotomy and peripheral arterial and venous cannulation. The procedure has evolved over the last year (n=44) to a minimalist aortic valve replacement with a minithoracotomy of 4cm over the 2^nd intercostal space and percutaneous peripheral cannulation with preclosing devices (Proglide). In all cases conventional aortic valve prosthesis were used (except 20 sutureless valves) which were tied in with CorNot.

Results

Mean duration of the minimalist SAVR (skin-to-skin) was 175±48 min. Cardiopulmonary bypass time was 112±9 min and xclamp time was 68±18 min. ICU stay was 1±1.8 days. Revision for bleeding occurred in 4 patients (=2.4%). 1 patients died. 2 patients suffered from stroke (=1.2%). Groin seromas were present in 5 pts in the first 122 cases (=4%) and none after percutaneous peripheral cannulation. There was no vascular problem after percutaneous peripheral cannulation. All patients (except 1) left the hospital within 7±3 days and showed an uneventful recovery.

Conclusion

SAVR has evolved to a minimalist procedure with excellent outcome. We believe that this approach can be a true alternative to TAVR with very low morbidity.