International Perfusion Association


New Approach for Combined Aortic Valve and Coronary Procedures Through the Left Anterior Minithoracotomy

Objective: We have developed a novel technique for accessing the aortic valve (AoV) through the left anterior minithoracotomy. This approach has been used in patients requiring both AoV surgery and coronary artery bypass grafting (CABG).

Methods: From April 2023 to July 2023 we performed 6 concomitant AoV procedures and CABG through the left anterior minithoracotomy. Mean age was 71.5 (SD: 5.8; 64; 82) years, mean left ventricular ejection fraction was 53% (SD: 12.1; 30; 60). Surgical technique includes left anterior minithoracotomy in the fourth intercostal space (ICS), peripheral cardiopulmonary bypass (CPB), aortic cross-clamping using transthoracic clamp, cold blood cardioplegia, conventional oblique aortotomy and special surgical exposure maneuvers, aimed to position the ascending aorta and aortic valve close to the surgical incision.

Results: AoV was effectively visualized and the procedure was performed as planned in all 6 patients. No conversion to sternotomy was required. AVR with biological prosthesis was performed in 6 (100%) patients. Conventional surgical instruments were used in all cases. The long-shafted instruments were not required. Knot-pusher was used in 4 (67%)cases.Concomitant complete revascularization was achieved in all cases. Mean number of distal anastomosis was 2.0 (SD : 0.6; 1; 3).Total operation time was-371 (SD: 43; 300; 420) min, CPB time was-253 (SD: 36; 193; 284) min, cross-clamp time was – 162 (SD: 29; 128; 214) min.ICU stay was-1.5 (SD: 0.55; 1; 2) days, total hospital stay was-7.3 (SD: 1; 6; 9) days. There were no revisions for bleeding, no strokes or other major complications, no hospital or 30-days mortality.

Conclusions: The simultaneous performance of AVR and multivessel CABG through a single left anterior thoracotomy is technically feasible and can be carried out by experienced surgeons. However, a larger number of cases are required to fully comprehend the potential limitations of this procedure.

Keywords: Coronary artery bypass grafting; Minimally invasive cardiac surgery; TCRAT; Total coronary revascularization via left anterior thoracotomy; aortic valve replacement; coronary artery disease.

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