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Chiu Modified parasternal approach for aortic valve surgery

procedures. After we developed this technique, it has 3. Bowdish ME, Hui DS, Cleveland JD, Mack WJ, Sinha R, Ranjan
become our standard practice and primary choice for R, Cohen RG, Baker CJ, Cunningham MJ, Barr ML, Starnes VA.
aortic valve surgery. Our propensity-adjusted analysis A comparison of aortic valve replacement via an anterior right
minithoracotomy with standard sternotomy: a propensity score
shows that the parasternal approach may be a good analysis of 492 patients. Eur J Cardiothorac Surg 2016;49:456-63.
minimally invasive alternative to full sternotomy for 4. Rodriguez E, Malaisrie SC, Mehall JR, Moore M, Salemi A, Ailawadi
cardiac valve operations. [6] G,Gunnarsson C, Ward AF, Grossi EA; Economic Workgroup on
Valvular Surgery. Right anterior thoracotomy aortic valve replacement
In conclusion, improved cosmetic results, less pain is associated with less cost than sternotomy-based approaches: a multi-
and anagelsic use, and faster recovery have been institution analysis of ‘real world’ data. J Med Econ 2014;12:846-52.
reported. It has been generally well-accepted by 5. Ito T, Maekawa A, Hoshino S, Hayashi Y. Right infra-axillary mini-
thoracotomy for aortic valve replacement. Ann Cardiothorac Surg
patients and also by surgeons performing minimally 2015;4:78-80.
invasive aortic valve replacement. [18] We agree that 6. Chiu KM, Chen RJ, LinTY, Chen JS, Huang JH, Huang CY, Chu
full sternotomy procedures have achieved excellent SH. Right mini-parasternotomy may be a good minimally invasive
surgical outcomes. It may not be easy to elaborate alternative to full sternotomy for cardiac valve operations-a
the differences in outcomes simply through various propensity-adjusted analysis. J Cardiovasc Surg 2016;57:111-20.
surgical incisions. Also, new approaches, if not been 7. Cosgrove DM 3rd, Sabik JF. Minimally invasive approach for aortic
well conducted, could be detrimental due to unfamiliar 8. valve operations. Ann Thorac Surg 1996;62:596-7.
Gillinov AM, Gelijns AC, Parides MK, DeRose JJ Jr, Moskowitz AJ,
and unexpected complications. Open mindedness Voisine P, Ailawadi G, Bouchard D, Smith PK, Mack MJ, Acker MA,
and curiosity, on-site case observations, and proctor Mullen JC, Rose EA, Chang HL, Puskas JD, Couderc JP, Gardner
guided practices by well-experienced surgeons are TJ, Varghese R, Horvath KA, Bolling SF, Michler RE, Geller NL,
key elements in adopting new approaches that can Ascheim DD, Miller MA, Bagiella E, Moquete EG, Williams P,
offer true benefits to selected patients. Preoperative Taddei-Peters WC, O’Gara PT, Blackstone EH, Argenziano M;
images help us to plan carefully and avoid potential CTSN Investigators. Surgical ablation of atrial fibrillation during
mitral-valve surgery. N Engl J Med 2015;372:1309-409.
complications. Starting with simple, isolated and 9. Glauber M, Gilmanov D, Farneti PA, Kallushi E, Miceli A,
straightforward procedures is always the rule of thumb Chiaramonti F, Murzi M, Solinas M. Right anterior minithoracotomy
to negotiate the learning curve of new techniques. From for aortic valve replacement: 10-year experience of a single center. J
our experience, our parasternal approach is an easily Thorac Cardiovasc Surg 2015;150:548-56.
learned and performed procedure. Our long-term 10. Johnston DR, Roselli EE. Minimally invasive aortic valve surgery:
[6]
follow up also proves that this a durable procedure. Cleveland Clinic experience. Ann Cardiothorac Surg 2015;4:140-7.
11. Youssef SJ, Millan JA, Youssef GM, Earnheart A, Lehr EJ, Barnhart
Authors’ contributions GR. The role of computed tomography angiography in patients
undergoing evaluation for minimally invasive cardiac surgery: an
K.M. Chiu contributed solely to this article. early program experience. Innovations (Phila) 2015;10:33-8.
12. Di Tomasso N, Monaco F, Landoni G. Renal protection in
cardiovascular surgery. F1000Res 2016;5:331.
Financial support and sponsorship 13. Bedeir K, Reardon M, Ramchandani M, Singh K, Ramlawi B.
None. Elevated stroke risk associated with femoral artery cannulation during
mitral valve surgery. Semin Thorac Cardiovasc Surg 2015;27:97-103.
Conflicts of interest 14. Lamelas J, Williams RF, Mawad M, LaPietra A. Complications
There are no conflicts of interest. associated with femoral cannulation during minimally invasive
cardiac surgery. Ann Thorac Surg 2017;103:1927-32.
15. Glauber M, Ferrarini M, Miceli A. Minimally invasive aortic valve
Patient consent surgery: state of the art and future directions. Ann Cardiothorac Surg
Patients’ informed consent were obtained before 2015;4:26-32.
operations. 16. Miceli A, Santarpino G, Pfeiffer S, Murzi M, Gilmanov D, Concistré
G, Quaini E, Solinas M, Fischlein T, Glauber M. Minimally invasive
aortic valve replacement with perceval S sutureless valve: early
Ethics approval outcomes and one-year survival from two European centers. J Thorac
This study is waived for ethical approval from the Cardiovasc Surg 2014;148:2838-43.
author’s institution review board. 17. Borger MA, Moustafine V, Conradi L, Knosalla C, Richter M, Merk
DR, Doenst T, Hammerschmidt R, Treede H, Dohmen P, Strauch JT. A
randomized multicenter trial of minimally invasive rapid deployment
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88 Mini-invasive Surgery ¦ Volume 1 ¦ June 30, 2017