Totally Endoscopic Aortic Valve Replacement Using the Three-dimensional Endoscope Masayoshi Tokoro 1 , Sadanari Sawaki 1 , Takahiro Ozeki 1 , Mamoru Orii 1 , Riku Kato 1 , Toshiaki Ito 1 1Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital Keyword: totally endoscopic surgery , aortic valve replacement (AVR) , trans-right axillary approach pp.510-515
Published Date 2020/7/1
DOI https://doi.org/10.15106/j_kyobu73_510
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Totally endoscopic aortic valve replacement (TE-AVR) is still challenging, and few series report exist even today. In 2015, we started to use three-dimensional (3D) endoscope and we also introduced TE-AVR.

Patient is placed in the partial left lateral position. The main wound is created in right antero-lateral 4th intercostal space through 4 cm skin incision. No rib spreader is used. 3D endoscope is inserted on the mid-axillary line. A 5 mm trocar was inserted in the 3rd intercostal space, thus creating 3-port setting similarly to that for endoscopic mitral valve surgery. All sutures are tied using a knot-pusher.

We have performed 106 cases of TE-AVR. Compared with transaxillary AVR, there were no significant differences between the 2 groups in the hospital deaths or MACCE. Postoperative hospital stays became shorter in totally endoscopic group.

In conclusion, TE-AVR was possible through 3 ports created in the right antero-lateral chest similarly to the endoscopic mitral valve surgery. Transaxillary approach seemed to be suitable for the TE-AVR. By adopting common approach for both mitral valve surgery and aortic valve surgery, endoscopic double valve surgery could be performed seamlessly.

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