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Minimally invasive surgical aortic valve replacement
  1. Marjan Jahangiri1,
  2. Azhar Hussain1,
  3. Enoch Akowuah2
  1. 1 Department of Cardiothoracic Surgery, St George’s Hospital, London, UK
  2. 2 Department of Cardiothoracic Surgery, South Tees NHS Foundation Trust, North Yorkshire, UK
  1. Correspondence to Professor Marjan Jahangiri, Department of Cardiothoracic Surgery, St. George’s Hospital, London SW17 OQT, UK; marjan.jahangiri{at}stgeorges.nhs.uk

Abstract

Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions as opposed to full sternotomy. It is performed using cardiopulmonary bypass with cardiac arrest. It benefits from potential advantages of a less invasive procedure. To date, over 14 000 MIAVR have been reported in the literature. Due to heterogeneity of the studies, different surgical techniques and mainly the non-randomised nature of these studies comparing MIAVR with conventional aortic valve replacement, it is difficult to draw definitive conclusions. The two main techniques of MIAVR are mini-sternotomy and right anterior mini-thoracotomy. Both techniques with other less common forms of MIAVR will be discussed in this review. The advantages, disadvantages and surgical pitfalls will be discussed. Some of the advantages include shorter intensive care and hospital stay, reduced perioperative blood loss, less pain, improved respiratory function and cosmesis. The possible disadvantage of longer bypass and cross-clamp times may be counter balanced by the recent sutureless and rapid deployment valves. Despite some of the benefits, MIAVR has not been adopted by a significant proportion of the surgeons possibly related to the learning curve and requirements for re-training. As MIAVR becomes more common, randomised trials comparing this technique with transcatheter aortic valve implantation is warranted. In addition, assessing quality of life including return to work and functional capacity is needed.

  • transcatheter valve interventions
  • aortic stenosis
  • valvular heart disease
  • aortic surgery
  • valve disease surgery
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Footnotes

  • Contributors MJ conceived and designed the review. MJ and AH extracted and analysed the data with assistance from EA. MJ, AH and EA drafted the manuscript. All authors critically reviewed the manuscript for intellectual content and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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