Why the study?
Total thoracoscopic aortic valve surgery has anatomical challenges, poor surgical field exposure, and limited operating space, leaving few studies evaluating this procedure.
Does total thoracoscopic aortic valve replacement improve early clinical outcomes compared to upper mini-sternotomy and conventional AVR in patients with aortic valve lesions?
Does total thoracoscopic aortic valve replacement improve early clinical outcomes compared to upper mini-sternotomy and conventional AVR in patients with aortic valve lesions?
Total thoracoscopic aortic valve replacement is safe and associated with less pain, less bleeding, and shorter hospital stays despite longer operative times compared to conventional and mini-sternotomy approaches.
Total thoracoscopic AVR appears feasible in select patients; leaves open comparative safety and efficacy versus conventional approaches pending randomized trials.
Background: With the promotion of minimally invasive concepts and advances in total thoracoscopic valve surgery, total thoracoscopic aortic valve surgery has become a new option for patients with aortic valve lesions. However, due to its anatomical characteristics, poor surgical field exposure and limited operating space, only a few centers have performed further studies on this procedure. Methods: We evaluate the safety and advantages of total thoracoscopic aortic valve replacement compared to the upper mini-sternotomy AVR group and the conventional AVR group with important perioperative data as well as early postoperative outcomes. Results: All patients successfully underwent elective surgery, with no intraoperative conversion or death occurring. Patients in the total thoracoscopy group had significantly prolonged CPB and aortic clamping (AC) times compared to the other two groups. The average Postoperative chest drainage in the first 24 h of the total thoracoscopic group was significantly less than the other two groups. The mean VAS pain score in the total thoracoscopic group was significantly less than the other two groups. In addition, the total thoracoscopic group had a significantly decreased ICU stay as well as the total hospital stay. Although the length of mechanical ventilation between groups did not show statistically significant differences, mechanical ventilation in the total thoracoscopy group had a smaller relative number. Conclusions: Despite the need for improvement, total thoracoscopic aortic valve replacement is safe, and may improve clinical outcome
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Song et al. (2021) studied this question.
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