Trans-axillary Aortic Valve Replacement

VernacularTitle:右腋窩小切開アプローチによる内視鏡補助下大動脈弁置換術
Author: Masakazu Aoki ; Toshiaki Ito
Publication Type:Journal Article
Keywords: minimally invasive cardiac surgery; aortic valve replacement; endoscopic assistance
From:Japanese Journal of Cardiovascular Surgery 2013;42(5):430-433
CountryJapan
Language:Japanese
Abstract: We have performed trans-axillary aortic valve replacement (TAX AVR) as a new minimally invasive approach in 5 patients with aortic regurgitation since September 2012. The mean age was 63 years (range 25-84 years). TAX AVR was performed through 7 cm skin incision along the right anterior axillary line, and small 4th intercostal thoracotomy. Cardiopulmonary bypass was established through the femoral artery and vein. Intra-thoracic procedures were performed under direct vision, or videoscopic assistance with the aid of minimally invasive surgical apparatus. The mean operative time was 312±44 min, cardiopulmonary bypass 217±38 min, and cross-clamp 139±22 min. The mean ventilation time was 4.2±6.1 h, and length of post-operative hospital stay was 14.8±0.9 days. There was no re-operation for bleeding, or conversion to median sternotomy. TAX AVR can avoid sternotomy, transection of rib, and sacrifice of internal thoracic artery. The postoperative wound was unrecognizable unless the right arm was raised. This approach may promise patients' early rehabilitation and better cosmetic results.