Totally endoscopic aortic valve replacement: Techniques and early results

Wenda Gu; Kan Zhou; Zhenzhong Wang; Xin Zang; Haijiang Guo; Qiang Gao; Yun Teng; Jian Liu; Biaochuan He; Huiming Guo; Huanlei Huang

doi:10.3389/fcvm.2022.1106845

Totally endoscopic aortic valve replacement: Techniques and early results

Front Cardiovasc Med. 2023 Jan 9:9:1106845. doi: 10.3389/fcvm.2022.1106845. eCollection 2022.

Authors

Wenda Gu¹, Kan Zhou¹, Zhenzhong Wang¹, Xin Zang¹, Haijiang Guo¹, Qiang Gao¹, Yun Teng¹, Jian Liu¹, Biaochuan He¹, Huiming Guo¹, Huanlei Huang^{1

2}

Affiliations

¹ Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.

Abstract

Objective: To demonstrate the technical details of total endoscopic aortic valve replacement using a standard prosthesis, compare the clinical effect and safety of endoscopic aortic valve replacement and traditional aortic valve replacement.

Methods: From 2020 to 2021, 60 consecutive patients underwent elective isolated aortic valve replacement (AVR). They were divided into two groups: the total endoscopic AVR group (TE-AVR group, 29 patients, nine women, aged 51.65 ± 11.79 years), and the traditional full-sternotomy group (AVR group, 31 patients, 13 women, aged 54.23 ± 12.06 years). Three working ports were adopted in the TE-AVR procedure.

Results: No patient died in either group. The cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time in the TE-AVR group were longer than those in the AVR group (CPB time: 177.6 ± 43.2 vs. 112.1 ± 18.1 min, p < 0.001; ACC time: 118.3 ± 29.7 vs. 67.0 ± 13.2 min, p < 0.001). However, the mechanical ventilation duration (14.2 ± 9.3 vs. 24.0 ± 18.9 h, p = 0.015) and postoperative hospital stay (6.0 ± 1.7 vs. 8.0 ± 4.5 days, p = 0.025) were shorter in patients of TE-AVR group than those of AVR group. Although the ICU stay (55.1 ± 26.9 vs. 61.5 ± 44.8 h, p = 0.509) and post-operative chest drainage of the first 24 h (229.8 ± 125.0 vs. 273.2 ± 103.2 ml, p = 0.146) revealed no statistical difference, there was a decreasing trend in the TE-AVR group. Among the patients of the TE-AVR group, two patients were converted to thoracotomy because of mild to moderate paravalvular leakage identified by intraoperative transesophageal echocardiography.

Conclusion: Total endoscopic aortic valve replacement is safe and feasible, with less trauma and quicker recovery.

Keywords: aortic valve replacement; endoscopic cardiac surgery; minimally invasive; standard prosthesis; total endoscopic.

Grants and funding

This study was supported by the Medical Science and Technology Research Foundation of Guangdong Province (No. 20191112191143286), Basic and Applied Basic Research Foundation of Guangdong Province (No. 2019B1515120071), and Guangdong Provincial Clinical Research Center Development Program.