Minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision: A single-center experience of 13 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JI Qiang ¹ , WANG Yulin ¹ , LI Jun ¹ , SUN Xiaoning ¹ , YANG Zhaohua ¹ , PAN Sun ¹ , LAI Hao ¹ ,  WANG Chunsheng ^1,2

1. Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, 200032, P.R.China;
2. Shanghai Municipal Institute for Cardiovascular Diseases, Shanghai, 200032, P.R.China;

Corresponding author：

WANG Chunsheng, Email: wang.chunsheng@zs-hospital.sh.cn

Keywords：

Minimally invasive cardiac surgery; right anterior second intercostal incision; minimally invasive Bentall operation; minimally invasive Wheat operation; minimally invasive ascending aorta replacement

DOI：

10.7507/1007-4848.202011043

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the feasibility, safety, and short-term effect of minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision.Methods The clinical data of 13 patients who underwent minimally invasive ascending aorta surgery (including minimally invasive Bentall operation in 7 patients, minimally invasive Wheat operation in 2 patients, and minimally invasive ascending aorta replacement in 4 patients) through a right anterior thoracotomy via the second intercostal incision in our center from October, 2019 to September, 2020 were retrospectively analyzed. There were 12 males and 1 female at age of 19-69 (52.4±13.7) years.Results The aortic cross-clamping time was 84.3±18.3 min. Three patients received blood transfusion, with the rate of 23.1%. The drainage volume in the first 24 hours after operation was 214.5±146.3 mL, with no redo for bleeding. The duration of mechanical ventilation was 19.0±11.3 hours and the length of intensive care unit stay was 1.8±1.3 days. The drainage tube was removed 2.5±1.0 days after operation. All the 13 patients recovered and discharged 6.4±2.0 days after operation, with no dead patients found. All patients survived with New York Heart Association (NYHA) functional classⅠandⅡduring a median follow-up of 8 months.Conclusion Minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision may be a safe and effective method with less injury and quick recovery.

Citation： JI Qiang, WANG Yulin, LI Jun, SUN Xiaoning, YANG Zhaohua, PAN Sun, LAI Hao, WANG Chunsheng. Minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision: A single-center experience of 13 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(2): 202-207. doi: 10.7507/1007-4848.202011043 Copy

1.	Ramchandani MK, Wyler VBM, Reardon MJ. Minimally invasive surgical aortic valve replacement through a right anterior thoracotomy: How I teach it. Ann Thorac Surg, 2019, 107(1): 19-23.
2.	Young CP, Sinha S, Vohra HA. Outcomes of minimally invasive aortic valve replacement surgery. Eur J Cardiothorac Surg, 2018, 53(suppl 2): I19-I23.
3.	Glower DD, Desai BS, Hughes GC, et al. Aortic valve replacement via right minithoracotomy versus median sternotomy: A propensity score analysis. Innovations (Phila), 2014, 9(2): 75-81, 81.
4.	Miceli A, Murzi M, Gilmanov D, et al. Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy. J Thorac Cardiovasc Surg, 2014, 148(1): 133-137.
5.	张永会, 张林, 李梁钢, 等. 微创切口与胸骨正中切口主动脉瓣置换术中倾向性评分匹配的对比研究. 中国心血管病研究, 2019, 17(12): 1079-1083.
6.	Jahangiri M, Hussain A, Akowuah E. Minimally invasive surgical aortic valve replacement. Heart, 2019, 105(Suppl 2): S10-S15.
7.	Stolinski J, Plicner D, Grudzien G, et al. A comparison of minimally invasive and standard aortic valve replacement. J Thorac Cardiovasc Surg, 2016, 152(4): 1030-1039.
8.	沈金强, 魏来, 夏利民, 等. 微创主动脉瓣置换术101例临床分析. 中华外科杂志, 2013, 51(3): 252-255.
9.	Chang C, Raza S, Altarabsheh SE, et al. Minimally invasive approaches to surgical aortic valve replacement: A meta-analysis. Ann Thorac Surg, 2018, 106(6): 1881-1889.
10.	Glauber M, Miceli A, Gilmanov D, et al. Right anterior minithoracotomy versus conventional aortic valve replacement: A propensity score matched study. J Thorac Cardiovasc Surg, 2013, 145(5): 1222-1226.
11.	Gasparovic I, Artemiou P, Hudec V, et al. Long-term outcomes following minimal invasive versus conventional aortic valve replacement: A propensity match analysis. Bratisl Lek Listy, 2017, 118(8): 479-484.
12.	Hiraoka A, Kuinose M, Chikazawa G, et al. Minimally invasive aortic valve replacement surgery: Comparison of port-access and conventional standard approach. Circ J, 2011, 75(7): 1656-1660.
13.	Doll N, Borger MA, Hain J, et al. Minimal access aortic valve replacement: Effects on morbidity and resource utilization. Ann Thorac Surg, 2002, 74(4): S1318-S1322.
14.	Bowdish ME, Hui DS, Cleveland JD, et al. A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy: A propensity score analysis of 492 patients. Eur J Cardiothorac Surg, 2016, 49(2): 456-463.
15.	Glauber M, Gilmanov D, Farneti PA, et al. Right anterior minithoracotomy for aortic valve replacement: 10-year experience of a single center. J Thorac Cardiovasc Surg, 2015, 150(3): 548-556.
16.	Malaisrie SC, Barnhart GR, Farivar RS, et al. Current era minimally invasive aortic valve replacement: techniques and practice. J Thorac Cardiovasc Surg, 2014, 147(1): 6-14.
17.	Loor G, Desai MY, Roselli EE. Pre-operative 3D CT imaging for virtual planning of minimally invasive aortic valve surgery. JACC Cardiovasc Imaging, 2013, 6(2): 269-271.
18.	Gilmanov D, Bevilacqua S, Murzi M, et al. Minimally invasive and conventional aortic valve replacement: A propensity score analysis. Ann Thorac Surg, 2013, 96(3): 837-843.

1. Ramchandani MK, Wyler VBM, Reardon MJ. Minimally invasive surgical aortic valve replacement through a right anterior thoracotomy: How I teach it. Ann Thorac Surg, 2019, 107(1): 19-23.
2. Young CP, Sinha S, Vohra HA. Outcomes of minimally invasive aortic valve replacement surgery. Eur J Cardiothorac Surg, 2018, 53(suppl 2): I19-I23.
3. Glower DD, Desai BS, Hughes GC, et al. Aortic valve replacement via right minithoracotomy versus median sternotomy: A propensity score analysis. Innovations (Phila), 2014, 9(2): 75-81, 81.
4. Miceli A, Murzi M, Gilmanov D, et al. Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy. J Thorac Cardiovasc Surg, 2014, 148(1): 133-137.
5. 张永会, 张林, 李梁钢, 等. 微创切口与胸骨正中切口主动脉瓣置换术中倾向性评分匹配的对比研究. 中国心血管病研究, 2019, 17(12): 1079-1083.
6. Jahangiri M, Hussain A, Akowuah E. Minimally invasive surgical aortic valve replacement. Heart, 2019, 105(Suppl 2): S10-S15.
7. Stolinski J, Plicner D, Grudzien G, et al. A comparison of minimally invasive and standard aortic valve replacement. J Thorac Cardiovasc Surg, 2016, 152(4): 1030-1039.
8. 沈金强, 魏来, 夏利民, 等. 微创主动脉瓣置换术101例临床分析. 中华外科杂志, 2013, 51(3): 252-255.
9. Chang C, Raza S, Altarabsheh SE, et al. Minimally invasive approaches to surgical aortic valve replacement: A meta-analysis. Ann Thorac Surg, 2018, 106(6): 1881-1889.
10. Glauber M, Miceli A, Gilmanov D, et al. Right anterior minithoracotomy versus conventional aortic valve replacement: A propensity score matched study. J Thorac Cardiovasc Surg, 2013, 145(5): 1222-1226.
11. Gasparovic I, Artemiou P, Hudec V, et al. Long-term outcomes following minimal invasive versus conventional aortic valve replacement: A propensity match analysis. Bratisl Lek Listy, 2017, 118(8): 479-484.
12. Hiraoka A, Kuinose M, Chikazawa G, et al. Minimally invasive aortic valve replacement surgery: Comparison of port-access and conventional standard approach. Circ J, 2011, 75(7): 1656-1660.
13. Doll N, Borger MA, Hain J, et al. Minimal access aortic valve replacement: Effects on morbidity and resource utilization. Ann Thorac Surg, 2002, 74(4): S1318-S1322.
14. Bowdish ME, Hui DS, Cleveland JD, et al. A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy: A propensity score analysis of 492 patients. Eur J Cardiothorac Surg, 2016, 49(2): 456-463.
15. Glauber M, Gilmanov D, Farneti PA, et al. Right anterior minithoracotomy for aortic valve replacement: 10-year experience of a single center. J Thorac Cardiovasc Surg, 2015, 150(3): 548-556.
16. Malaisrie SC, Barnhart GR, Farivar RS, et al. Current era minimally invasive aortic valve replacement: techniques and practice. J Thorac Cardiovasc Surg, 2014, 147(1): 6-14.
17. Loor G, Desai MY, Roselli EE. Pre-operative 3D CT imaging for virtual planning of minimally invasive aortic valve surgery. JACC Cardiovasc Imaging, 2013, 6(2): 269-271.
18. Gilmanov D, Bevilacqua S, Murzi M, et al. Minimally invasive and conventional aortic valve replacement: A propensity score analysis. Ann Thorac Surg, 2013, 96(3): 837-843.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision: A single-center experience of 13 patients

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