One-Access Concept for Minimally Invasive Valve Surgery

Objectives: Minimally invasive valve surgery is the result of the increasing patient’s demand for less surgical trauma, less pain, faster recovery and also improved cosmetics. Hereby, Cardiac Surgery has to ensure that the excellent results of “sternotomy-procedures” can be transported into minimally invasive surgery. The thesis was, that using one access for multiple procedures—like we are used to do with sternotomy—results in highly trained surgical individuals and subsequently in superior results. The presented “One-access concept” wants to translate this concept into minimally invasive valve surgery.

Methods: For those purposes, a “right lateral” or “trans-axillary” access was established. Through a 5-cm skin incision in the right anterior axillary line, the 3rd intercostal space is opened. ECC is established by femoral cannulation. Through that right lateral access, the aortic valve, the mitral valve as well as the tricuspid valve are accessible without changing anything in the setup.

Results: Since January 2018, out of a total of 422 minimally invasive valve procedures, 173 patients underwent valve surgery using the right lateral access. These consisted of 45 isolated aortic valve surgeries, 98 isolated mitral valve procedures, 8 combined aortic and mitral valve procedures, 11 combined mitral and tricuspid valve procedures, 3 isolated tricuspid valve procedures, 5 ASD closures, and 3 myxoma resections. The procedures were uneventful. Postoperative access-related morbidity consisted of aerodermectasia (6.9%), lymphatic fistula of the groin (2.3%), rethoracotomy for bleeding (1.7%). No impaired wound healing was observed at the thoracal access site. The access related morbidity could be shown to decrease after an initial learning period. Except a headlight and MICS instruments no fancy or expensive equipment was necessary.

Conclusion: The right lateral access allows minimally invasive isolated, double or even triple (theoretically) valve procedures through one and the same access. Continuous training in one access for all valves resulted in low access related morbidity, shorter procedure times, extended indications and broader acceptance within the institution. The approach is cheap, safe, reproducible, can easily be implemented, and thus is no “one or two man show.”

No conflict of interest has been declared by the author(s).