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Heart and Vessels

, Volume 34, Issue 3, pp 462–469 | Cite as

Minimally invasive aortic valve replacement through a right anterolateral mini-thoracotomy for the treatment of octogenarians with aortic valve stenosis

  • Toshinori TotsugawaEmail author
  • Arudo Hiraoka
  • Kentaro Tamura
  • Hidenori Yoshitaka
  • Taichi Sakaguchi
Original Article
  • 56 Downloads

Abstract

Because of concerns about the high risk of perioperative complications, the feasibility of minimally invasive aortic valve replacement (MIAVR) for elderly patients remains controversial. Here, we review our results of MIAVR in octogenarians with aortic valve stenosis (AS). Between October 2012 and December 2017, 110 patients with AS underwent MIAVR via a right anterolateral mini-thoracotomy; 41 patients were octogenarian (Group O). The perioperative outcomes of these patients were compared with those of the 69 patients who were less than 80 years of age (Group Y). A preoperative contrast-enhanced computed tomography (CT) scan was performed in all patients to guide the patient selection and aid the decision regarding cannulation sites. Among all cases of isolated aortic valve replacement, MIAVR accounted for 47% cases during this study period. The mean age of Group O was 83.6 ± 2.9 years, with a maximum age of 89. In Group O, there were no in-hospital deaths or morbidity, including stroke. The rate of blood transfusion was significantly higher in Group O than in Group Y (P = 0.01). However, there was no significant difference in ventilation time, the length of intensive care unit stay, the length of hospital stay, or in the rates of cumulative survival and freedom from valve-related complications. With careful patient selection and a perfusion strategy based on preoperative CT scan, equivalent outcomes of MIAVR were even achieved in octogenarians.

Keywords

Minimally invasive aortic valve replacement Aortic stenosis Anterolateral thoracotomy Octogenarian 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

References

  1. 1.
    Herrmann HC, Thourani VH, Kodali SK, Makkar RR, Szeto WY, Anwaruddin S, Desai N, Lim S, Malaisrie SC, Kereiakes DJ, Ramee S, Greason KL, Kapadia S, Babaliaros V, Hahn RT, Pibarot P, Weissman NJ, Leipsic J, Whisenant BK, Webb JG, Mack MJ, Leon MB, PARTNER 2 Investigators (2016) One-year clinical outcomes with SAPIEN 3 transcatheter aortic valve replacement in high-risk and inoperable patients with severe aortic stenosis. Circulation 134:130–140CrossRefGoogle Scholar
  2. 2.
    Gilmanov D, Farneti PA, Ferrarini M, Santarelli F, Murzi M, Miceli A, Solinas M, Glauber M (2015) Full sternotomy versus right anterior minithoracotomy for isolated aortic valve replacement in octogenarians: a propensity-matched study. Interact Cardiovasc Thorac Surg 20:732–741CrossRefGoogle Scholar
  3. 3.
    Falk V, Cheng DC, Martin J, Diegeler A, Folliguet TA, Nifong LW, Perier P, Raanani E, Smith JM, Seeburger J (2011) Minimally invasive versus open mitral valve surgery: a consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010. Innovations (Phila) 6:66–76Google Scholar
  4. 4.
    Totsugawa T, Kuinose M, Hiraoka A, Yoshitaka H, Tamura K, Sakaguchi T (2014) Anterolateral approach for minimally invasive aortic valve replacement. Gen Thorac Cardiovasc Surg 62:290–295CrossRefGoogle Scholar
  5. 5.
    Hiraoka A, Nakajima K, Kuinose M, Totsugawa T, Yoshitaka H (2014) Initial large-dose administration of modified St. Thomas' solution. Asian Cardiovasc Thorac Ann 22:267–271CrossRefGoogle Scholar
  6. 6.
    Di Tommaso L, Stassano P, Mannacio V, Russolillo V, Monaco M, Pinna G, Vosa C (2013) Asymmetric septal hypertrophy in patients with severe aortic stenosis: the usefulness of associated septal myectomy. J Thorac Cardiovasc Surg 145:171–175CrossRefGoogle Scholar
  7. 7.
    Sakamoto K, Totsugawa T, Hiraoka A, Tamura K, Yoshitaka H, Sakaguchi T (2018) Minimally invasive aortic valve replacement following root enlargement on too narrow annulus to perform transcatheter aortic valve implantation. Int Heart J 59:634–636CrossRefGoogle Scholar
  8. 8.
    Totsugawa T, Suzuki K, Hiraoka A, Tamura K, Yoshitaka H, Sakaguchi T (2017) Concomitant septal myectomy during minimally invasive aortic valve replacement through a right mini-thoracotomy for the treatment of aortic stenosis with systolic anterior motion of the mitral valve. Gen Thorac Cardiovasc Surg 65:657–660CrossRefGoogle Scholar
  9. 9.
    Brown ML, McKellar SH, Sundt TM, Schaff HV (2009) Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 137:670–679CrossRefGoogle Scholar
  10. 10.
    Glauber M, Miceli A, Gilmanov D, Ferrarini M, Bevilacqua S, Farneti PA, Solinas M (2013) Right anterior minithoracotomy versus conventional aortic valve replacement: a propensity score matched study. J Thorac Cardiovasc Surg 145:1222–1226CrossRefGoogle Scholar
  11. 11.
    Hiraoka A, Totsugawa T, Kuinose M, Nakajima K, Chikazawa G, Tamura K, Yoshitaka H, Sakaguchi T (2014) Propensity score-matched analysis of minimally invasive aortic valve replacement. Circ J 78:2876–2881CrossRefGoogle Scholar
  12. 12.
    Ito T, Maekawa A, Hoshino S, Hayashi Y (2013) Right infraaxillary thoracotomy for minimally invasive aortic valve replacement. Ann Thorac Surg 96:715–717CrossRefGoogle Scholar
  13. 13.
    Miceli A, Santarpino G, Pfeiffer S, Murzi M, Gilmanov D, Concistré G, Quaini E, Solinas M, Fischlein T, Glauber M (2014) Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy. J Thorac Cardiovasc Surg 148:133–137CrossRefGoogle Scholar
  14. 14.
    Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG, PARTNER 2 Investigators (2016) transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374:1609–1620CrossRefGoogle Scholar
  15. 15.
    Miceli A, Gilmanov D, Murzi M, Marchi F, Ferrarini M, Cerillo AG, Quaini E, Solinas M, Berti S, Glauber M (2016) Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients. Eur J Cardiothorac Surg 49:960–965CrossRefGoogle Scholar
  16. 16.
    Vasa-Nicotera M, Sinning JM, Chin D, Lim TK, Spyt T, Jilaihawi H, Grube E, Werner N, Nickenig G, Kovac J (2012) Impact of paravalvular leakage on outcome in patients after transcatheter aortic valve implantation. JACC Cardiovasc Interv 5:858–865CrossRefGoogle Scholar
  17. 17.
    Lamelas J (2015) Minimally invasive concomitant aortic and mitral valve surgery: the "Miami Method". Ann Cardiothorac Surg 4:33–37Google Scholar
  18. 18.
    Totsugawa T, Hiraoka A, Tamura K, Yoshitaka H, Sakaguchi T (2017) Clamp ablation of pulmonary veins during minimally invasive aortic valve replacement. Ann Thorac Surg 104:e471–e473CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiovascular SurgeryThe Sakakibara Heart Institute of OkayamaOkayamaJapan

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