초록접수 현황
| 20F-136 | Video session발표 |
Mini-Thoracotomy Approach for Combined Aortic Valve Replacement
Kinam Shin ¹, Hong Rae Kim¹, Joon Bum Kim¹
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : Even in the era of expanding minimally invasive cardiac surgery, aortic valve replacement (AVR) concomitantly with other valvular or anti-arrhythmic procedures are usually performed through conventional full sternotomy. Here we share our experiences with mini-access AVR combined with other cardiac procedures through right mini-throacotomy.
Methods : The surgical access involves a 6cm right mini-thoracotomy incision through 4th intercostal space accompanied with thoracoscopic guidance as for usual mini-access mitral procedures. Cardiopulmonary bypass was established by groin access. For a reproducible exposure of the aortic valve, commissural exposure stitches were made at the each commissure, and these were suspended by anchoring the thread against corresponding pericardium.
Results : A total of 16 patients (66.1±10.0 years; 9 females) underwent the mini-access combined AVR from January 2018 to August 2020. Baseline EuroSCORE II was Euroscore 2.6 (IQR 1.8-3.7). AVR+mitral valve replacement was performed in 9 patients (56.3 %), and details of operation are listed in Table 1. A sutureless/rapid-deployment AVR was used in 5 patients (31.3 %). Mean aortic cross-clamping and cardiopulmonary bypass times were 107.7 ± 38.9 min and 156.8 ± 51.7 min, respectively. There was no early mortality, postoperative neurologic injury, low-cardiac output syndrome or new-dialysis, however, 1 patient (6.25 %) required reoperation for bleeding. The median length of stays in intensive care unit and hospitalization were 1 day (interquartile range (IQR), 1.00-1.25 days), and 8 days (IQR, 6.75-10 days), respectively.
Conclusion : Our preliminary results indicate that mini-access AVR combined with other cardiac procedures is a safe and efficient approach pending further validation by larger eperiences.
Methods : The surgical access involves a 6cm right mini-thoracotomy incision through 4th intercostal space accompanied with thoracoscopic guidance as for usual mini-access mitral procedures. Cardiopulmonary bypass was established by groin access. For a reproducible exposure of the aortic valve, commissural exposure stitches were made at the each commissure, and these were suspended by anchoring the thread against corresponding pericardium.
Results : A total of 16 patients (66.1±10.0 years; 9 females) underwent the mini-access combined AVR from January 2018 to August 2020. Baseline EuroSCORE II was Euroscore 2.6 (IQR 1.8-3.7). AVR+mitral valve replacement was performed in 9 patients (56.3 %), and details of operation are listed in Table 1. A sutureless/rapid-deployment AVR was used in 5 patients (31.3 %). Mean aortic cross-clamping and cardiopulmonary bypass times were 107.7 ± 38.9 min and 156.8 ± 51.7 min, respectively. There was no early mortality, postoperative neurologic injury, low-cardiac output syndrome or new-dialysis, however, 1 patient (6.25 %) required reoperation for bleeding. The median length of stays in intensive care unit and hospitalization were 1 day (interquartile range (IQR), 1.00-1.25 days), and 8 days (IQR, 6.75-10 days), respectively.
Conclusion : Our preliminary results indicate that mini-access AVR combined with other cardiac procedures is a safe and efficient approach pending further validation by larger eperiences.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Hong Rae Kim, E-mail : khrjsk@gmail.com