Key result
Simultaneous AVR and multivessel CABG via single LAmT achieves 100% procedural success without 30-day mortality.
Why the study?
A novel technique was developed to access the aortic valve through a left anterior minithoracotomy for patients requiring both aortic valve surgery and coronary artery bypass grafting.
Is concomitant aortic valve replacement and multivessel CABG through a left anterior minithoracotomy feasible and safe in patients requiring both procedures?
Observational (n=6)
Is concomitant aortic valve replacement and multivessel CABG through a left anterior minithoracotomy feasible and safe in patients requiring both procedures?
Simultaneous aortic valve replacement and multivessel CABG through a single left anterior minithoracotomy is technically feasible and safe in a small initial case series.
Feasible in small series without early failure; leaves open safety for wider use pending larger prospective data.
OBJECTIVES: We have developed a novel technique for accessing the aortic valve (AoV) through the left anterior minithoracotomy (LAmT). This approach has been used in patients requiring both AoV surgery and coronary artery bypass grafting (CABG). METHODS: From April 2023 to July 2023, we performed 6 concomitant AoV procedures and CABG through the LAmT. The mean age was 71.5 [standard deviation (SD): 5.8; 64; 82] years, and the mean left ventricular ejection fraction was 53% (SD: 12.1; 30; 60). Surgical technique includes LAmT in the fourth intercostal space, peripheral cardiopulmonary bypass, aortic cross-clamping using transthoracic clamp, cold blood cardioplegia, conventional oblique aortotomy and special surgical exposure manoeuvres, aimed to position the ascending aorta and AoV close to the surgical incision. RESULTS: AoV was effectively visualized and the procedure was performed as planned in all 6 patients. No conversion to sternotomy was required. AoV replacement with biological prosthesis was performed in 6 (100%) patients. Conventional surgical instruments were used in all cases. The long-shafted instruments were not required. Knot-pusher was used in 4 (67%)cases. Concomitant complete revascularization was achieved in all cases. The mean number of distal anastomosis was 2.0 (SD: 0.6; 1; 3). Total operation time was 371 (SD: 43; 300; 420) min, cardiopulmonary bypass time was 253 (SD: 36; 193; 284) min and cross-clamp time was - 162 (SD: 29; 128; 214) min. intensive care unit stay was-1.5 (SD: 0.55; 1; 2) days, total hospital stay was-7.3 (SD: 1; 6; 9) days. There were no revisions for bleeding, no strokes or other major complications, and no hospital or 30-days mortality. CONCLUSIONS: The simultaneous performance of AoV replacement and multivessel CABG through a single left anterior thoracotomy is technically feasible and can be carried out by experienced surgeons. However, a larger number of cases are required to fully comprehend the potential limitations of this procedure.
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Babliak et al. (2024) conducted an observational in Aortic valve disease and coronary artery disease requiring surgery (n=6). Combined aortic valve and coronary procedures through the left anterior minithoracotomy was evaluated on Procedural success, conversion to sternotomy, and 30-day mortality. Simultaneous aortic valve replacement and multivessel CABG through a single left anterior thoracotomy was successfully performed in 6 patients with no conversions to sternotomy or 30-day mortality.
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