The First 100 Cases of Two Innovations: Video-Assisted Minimally Invasive Aortic Valve Replacement through Right Anterior Minithoracotomy Combined with INSPIRIS RESILIA Aortic Valve

Objectives: In the era of minimally invasive cardiac surgery represents right anterior mini thoracotomy as promising approach for aortic valve replacement. Combined with the INSPIRIS RESILIA prosthesis with suspected long-term resistance to valve deterioration elevates the aortic valve surgery to next elegantly advanced level. We describe herein our preliminary institutional experience of the combination of these two innovations in 100 patients.

Methods: Between April 2016 and June 2019, a total of 100 consecutive patients underwent video-assisted minimally invasive valve replacement through right anterior minithoracotomy with INSPIRIS RESILIA Aortic Valve. Cannulation for CPB was performed through femoral vessels in all patients. Patient’s mean age was 56 ± 12 years and 76% were men. Arterial hypertension, NYHA I/II, diabetes mellitus, COPD and peripheral artery disease represented in 73, 61, 36, 19, and 9% of patients, respectively. Degenerative aortic valve stenosis, aortic valve regurgitation, and aortic valve endocarditis were performed in 93, 5, and 2% of patients. Elective, redo, and emergent surgeries were performed in 86, 11, and 3%, respectively. Clinical data were prospectively entered into our institutional database.

Results: Cardiopulmonary bypass time and cross-clamping time were 79 ± 38 minutes and 41 ± 17 minutes, respectively. Intraoperative mortality, 30-day mortality, cerebrovascular event, rethoracotomy for bleeding, valve-related reoperation, RIMA injury, and conversion to sternotomy were zero. Pacemaker was implanted in one patient. Intensive care stay and hospital stay were 2 ± 1 and 6 ± 3 days, respectively. Postoperative dialysis was necessary in one patient. No structural valve deterioration and paravalvular leak were seen. EOA was 1.7 ± 0.8 cm². Pmax and Pmean were 15 ± 3 and 10 ± 2 mm Hg, respectively.

Conclusion: Our preliminary experience suggests that combination of minimally invasive access through right mini-thoracotomy for aortic valve replacement with INSPIRIS RESILIA can safely, effectively and reproducibly be performed. Further larger studies are needed to evaluate the long-term efficacy and durability of the new valve.