Aortic Valve Replacement With Right Anterior Thoracotomy, Sutureless Valves, and Ultrafast-Track Anesthesia: A Truly Minimally Invasive Approach in Ancona

While anatomical and clinical indications to transcatheter aortic valve interventions are expanding, surgical aortic valve replacement (AVR) continues to progress, as demonstrated by improving clinical outcomes in contemporary patients’ cohorts (1-2). However, mainly due to the availability of significantly less invasive transcatheter cardiac and noncardiac interventions, patients’ expectations have dramatically changed in the last decade with reduced trauma and fast recovery now being strongly valued. Such requests should not be ignored by the surgical community. Rather, an increased employment of minimally invasive multidisciplinary approaches should call surgeons, anesthesiologists, perfusionists, nurses, and physiotherapists to more efficacious collaborative efforts, which are crucial to really minimize surgical invasiveness as well as to decrease the psychological impact of surgery and hasten the patient’s return to their preoperative lifestyle.<div><p>Based on this notion, in Ancona, Italy, the authors are increasingly offering a 360° minimally invasive approach using the latest techniques and technologies for patients who require surgical AVR (3). This involves minimized incisions such as upper ministernotomy or right anterior minithoracotomy, sutureless or rapid deployment valves, minimally invasive extracorporeal circulation, and ultrafast-track anesthetic protocols that allow activating very early and aggressive rehab programs (4). In this video, the authors share their approach in a step-by-step fashion. The approach involves a right anterior minithoracotomy, the implantation of a sutureless LivaNova Perceval® S Valve, and the use of fast-track anesthetic protocols.</p><hr><p><strong>References</strong></p><ol><li>Holzhey D, Mohr FW, Walther T, et al. Current results of surgical aortic valve replacement: insights from the German Aortic Valve Registry. <em><a href="https://doi.org/10.1016/j.athoracsur.2015.07.090">Ann Thorac Surg. 2016;101:658-666</a></em>.</li><li>Di Eusanio M, Phan K, Berretta P, et al. Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients [published online ahead of print March 30, 2018]. <em><a href="https://doi.org/10.1093/ejcts/ezy132">Eur J Cardiothorac Surg</a></em>.</li><li>Di Eusanio M, Vessella W, Carozza R, et al. Ultra fast-track minimally invasive aortic valve replacement: going beyond reduced incisions. <em><a href="https://doi.org/10.1093/ejcts/ezx508">Eur J Cardiothorac Surg. 2018;53(Suppl2):ii14-ii18</a></em>.</li><li>Di Eusanio M, Vessella W, Carozza R, Munch C, Berretta P. Ultra Fast Track Mini AVR with Edwards Intuity Elite. <a href="https://www.ctsnet.org/article/ultra-fast-track-mini-avr-edwards-intuity-elite">https://www.ctsnet.org/article/ultra-fast-track-mini-avr-edwards-intuity-elite</a> Published January 31, 2017.</li></ol></div>