Minimally Invasive Aortic Valve Surgery

Abstract

Minimally invasive aortic valve surgery (MIAVS) is defined as aortic valve surgery through a small chest wall incision that does not include the conventional full sternotomy. MIAVS is increasing and has now become an alternative to full sternotomy with the aim to reduce the “invasiveness” of the surgical procedure, while maintaining the same efficacy, quality and safety that is associated with the conventional approach. The most common approaches for MIAVS are the ministernotomy and the right anterior minithoracotomy. Compared with conventional surgery, MIAVS has been shown to reduce postoperative mortality and morbidity, providing faster recovery, shorter hospital stay and better cosmetics results with utilization of less rehabilitation resources and consequently cost reduction. Despite these advantages, MIAVS is limited by the longer cross clamp and cardiopulmonary bypass times, which have raised some concerns in fragile and high risk patients. However, with the introduction of sutureless and rapid deployment valves, operative times have dramatically reduced by 35-40%. One could argue that minimally invasive aortic valve replacement using sutureless valves may be the real alternative to the transcatheter aortic valve implantation procedures in high risk patients “operable” patients. A prospective randomized trial is required to confirm this hypothesis. This chapter provides an overview of rationale, technical aspects, outcomes, concerns and controversies associated with MIAVS.