Valvular heart disease epidemiology has been dramatically chanced over the past decades in developed nations, mainly due to the decreased prevalence of rheumatic heart disease.
Due to this growing number of cases and the necessity to reduce the surgical trauma, numerous alternative incisions to the median sternotomy were evaluated. Minimally invasive aortic valve surgery is now most commonly performed via a limited skin incision, with a partial upper sternotomy that extends into the third or fourth intercostal space (also known as a ‘J’-sternotomy or reversed-L-shaped sternotomy). Right anterior thoracotomy (RAMT) for aortic valve replacement (AVR) represents a further step towards reduced invasiveness and functional operations. In our Center, RAMT was adopted after a 10-year-long program of minimally invasive mitral valve surgery, from which we redeployed technical skill and technological instrumentation.
In our view, RAMT can be adopted after careful patients’ selection, integrating clinical and imaging data that we discuss in this chapter; operative details are also described since those are the critical keypoints of the procedure itself. Furthermore, the advent of rapid deployment and sutureless valves favoured the spread of this approach; in our CUSUM analysis a clear absence of the learning curve was found when surgeons are proctored, due to a “transmitted learning” effect.
This is a preview of subscription content, log in to check access.
Brown JM, et al. Isolated aortic valve replacement in north america comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the society of thoracic surgeons national database. J Thorac Cardiovasc Surg. 2009;137:82–90.CrossRefPubMedGoogle Scholar
Ammar R, Porat E, Eisenberg DS, Uretzky G. Utility of spiral ct in minimally invasive approach for aortic valve replacement. Eur J Cardiothorac Surg. 1998;14(Suppl 1):S130–3.CrossRefPubMedGoogle Scholar
Gilmanov D, et al. Minimally invasive aortic valve replacement: 12-year single center experience. Ann Cardiothorac Surg. 2015;4:160–9.PubMedPubMedCentralGoogle Scholar
Concistrè G, Farneti P, Miceli A, Glauber M. Sutureless aortic bioprosthesis in severe aortic root calcification: an innovative approach. Interact Cardiovasc Thorac Surg. 2012;14:670–2.CrossRefPubMedPubMedCentralGoogle Scholar
Lio A, Scafuri A, Nicolò F, Chiariello L. Valve replacement with a sutureless aortic prosthesis in a patient with concomitant mitral valve disease and severe aortic root calcification. Tex Heart Inst J. 2016;43:186–8.CrossRefPubMedPubMedCentralGoogle Scholar
Nguyen A, et al. Sutureless aortic valve replacement in patients who have bicuspid aortic valve. J Thorac Cardiovasc Surg. 2015;150:851–7.CrossRefPubMedGoogle Scholar
Margaryan R, et al. Sutureless aortic valve prosthesis sizing: estimation and prediction using multidetector-row computed tomography. Innovations (Phila). 2015;10:230–5. discussion 235.CrossRefGoogle Scholar
Wharton G, et al. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the british society of echocardiography. Echo Res Pract. 2015;2:G9–G24.CrossRefPubMedPubMedCentralGoogle Scholar
Stoliński J, et al. Respiratory system function in patients after aortic valve replacement through right anterior minithoracotomy. Thorac Cardiovasc Surg. 2016;65(3):182–90.CrossRefPubMedGoogle Scholar
Gilmanov DS, et al. Hybrid treatment for aortic stenosis and cad: minimally invasive sutureless aortic valve replacement and delayed pci. In: 10th International Congress of Update in Cardiology and Cardiovascular Surgery; 2014. p. S61.Google Scholar
Saroul C, Keller G, Benaissa M, Lehot JJ. Anesthesia for minimally invasive cardiac procedure. Ann Fr Anesth Reanim. 2011;30(Suppl 1):S38–43.CrossRefPubMedGoogle Scholar
Murzi M, et al. Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon’s experience with a right minithoracotomy approach for aortic valve replacement. Eur J Cardiothorac Surg. 2012;41:1242–6.CrossRefPubMedGoogle Scholar
Murzi M, et al. Exploring the learning curve for minimally invasive sutureless aortic valve replacement. J Thorac Cardiovasc Surg. 2016;152(6):1537–1546.e1.CrossRefPubMedGoogle Scholar
Brown ML, McKellar SH, Sundt TM, Schaff HV. Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2009;137:670–679.e5.CrossRefPubMedGoogle Scholar
Phan K, Xie A, Di Eusanio M, Yan TD. A meta-analysis of minimally invasive versus conventional sternotomy for aortic valve replacement. Ann Thorac Surg. 2014;98:1499–511.CrossRefPubMedGoogle Scholar
Lim JY, et al. Conventional versus minimally invasive aortic valve replacement: pooled analysis of propensity-matched data. J Card Surg. 2015;30:125–34.CrossRefPubMedGoogle Scholar
Phan K, Zhou JJ, Niranjan N, Di Eusanio M, Yan TD. Minimally invasive reoperative aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2015;4:15–25.PubMedPubMedCentralGoogle Scholar
Borger MA, et al. A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement. Ann Thorac Surg. 2015;99:17–25.CrossRefPubMedGoogle Scholar
Head SJ, et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J. 2012;33:1518–29.CrossRefPubMedGoogle Scholar
Wilbring M, Alexiou K, Schumann E, Matschke K, Tugtekin SM. Isolated aortic valve replacement in patients with small aortic annulus-a high-risk group on long-term follow-up. Thorac Cardiovasc Surg. 2013;61:379–85.PubMedGoogle Scholar
Shrestha M, et al. Aortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future? Interact Cardiovasc Thorac Surg. 2013;17:778–82. discussion 782.CrossRefPubMedPubMedCentralGoogle Scholar
Athappan G, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61:1585–95.CrossRefPubMedGoogle Scholar