Minimally Invasive Aortic Valve and Hemi-arch Replacement

The traditional approach for aortic valve replacement and ascending thoracic aortic aneurysm repair was done via a full sternotomy (approximately, a 20 cm midline incision). This video demonstrates the key steps of Mini-AVR and Hemi-arch Replacement performed via a 5 cm minimal access incision. There was no transfusion required…

Minimally Invasive Mitral Valve Repair

A 54 year-old man was found to have severe mitral regurgitation as a result of posterior leaflet prolapse. His mitral valve was repaired successfully via a 3 cm access incision. He was extubated immediately after the surgery and discharged home on postoperative day 5.

Mini-Bentall and Hemi-arch Replacement – 6 cm Access Incision

This is a 60 year-old man with a leaking bicuspid aortic valve and 5 cm ascending thoracic aortic aneurysm. He underwent a Mini-Bentall Procedure and Hemi-arch Replacement via a 6 cm access incision. No transfusion was required. He was extubated 20 minutes later and discharged home on postoperative day 5.

Minimally Invasive AVR and Bypass Surgery

This 87 year-old lady had critical aortic stenosis and 90% blockage in the proximal right coronary artery. She underwent a Mini-AVR using EDWARDS INTUITY Elite valve system and right coronary artery bypass surgery via a 5 cm access incision.

Minimally Invasive Total Arch Replacement and Frozen Elephant Trunk

This patient presented with a large distal arch and proximal descending aortic aneurysm (7 cm). He underwent a Total Arch Replacement and Frozen Elephant Trunk Procedure using the Thoraflex Hybrid Graft (Vascutek Terumo). The entire operation was performed via a hemi-sternotomy (half incision size). He had an enhanced recovery and was discharged home on postoperative day 6.

Mini-Bentall Procedure and Hemi-arch Replacement (II)

This 52 year-old lady was referred to me with a 5.9 cm ascending thoracic aortic aneurysm and a stenotic bicuspid aortic valve. I performed an aortic root and hemi-arch replacement via a 7 cm incision (also known as the “Mini-Bentall Procedure”). The patient was extubated 20 minutes after the surgery and discharged home on postoperative day 5 without any complications.

Mini-AVR & Hemi-arch Replacement

This video demonstrates a minimally invasive aortic valve replacement and hemi-arch replacement procedure. The patient was a 57 year-old man who initially presented with syncope. He had a known bicuspid aortic valve, associated with a 4.5 cm ascending aortic and proximal aortic arch aneurysm. His aortic stenosis was severe with an aortic valve area of 0.5 cm2 and a mean gradient of 72 mmHg. He underwent this mini-AVR and hemi-arch replacement procedure via a 7 cm incision. He did not require any transfusion and was extubated on the operating table. He was discharged home within a week without any complications…

Mini-Bentall Procedure and Hemiarch Replacement

This is a 52 year-old man who was found to have a leaking bicuspid aortic valve and a 5.2 cm aneurysm, extending from the aortic root to the proximal arch. He underwent a minimally invasive aortic root replacement (Mini-Bentall Procedure) and hemiarch replacement via a 7 cm access incision. He was extubated in the operating room immediately after the surgery. He had an enhanced postoperative recovery and was discharged home on postoperative day 6.

Enhanced Recovery – Minimally Invasive Aortic Surgery

The suitability for minimally invasive aortic and cardiac surgery is assessed on an individual basis. It depends on the patient’s heart function, chest anatomy and co-existing medical conditions. If a patient is considered to be suitable for a minimally invasive approach, the patient is more likely to have an enhanced postoperative recovery course.

Mini-Bentall Procedure

A “Mini-Bentall” procedure is an aortic root replacement with re-construction of coronary buttons, performed via a minimally invasive approach. The patient was a body builder who was found to have a leaking pseudo-unicuspid aortic valve, a 4.5 cm aortic root aneurysm and a 4.5 cm mid ascending aortic aneurysm. In this particular case, the patient had an aortic root and ascending aortic replacement via an 8 cm access incision (less than half of that for a traditional sternotomy). There was no blood transfusion and the patient was extubated on the table in the operating theatre, 20 minutes after the surgery. He was discharged home one week after the procedure without any complications.

ARCH Projects – International Aortic Arch Surgery Study Group (IAASSG)

The International Aortic Arch Surgery Study Group is a global collaboration of over 30 hospitals from 10 countries, with the primary aim of conducting studies to assess the impact of varying surgical techniques on mortality and morbidity, identify predictors for neurological and operative risk, formulate and validate risk predictor models and review long-term survival outcomes and quality-of-life after arch surgery.
For more information visit www.archprojects.org.

 

For more surgical videos, please visit Annals of Cardiothoracic Surgery (ACS) or ASVIDE surgical video database.