Minimally invasive aortic valve replacement (MIAVR)

I had a chance to take care of a patient who had multiple heart problems. He had CABG open hart surgery in the past. Now the patient developed heart valve problems and needed another surgery. However, the doctor stated that last surgery led to a complication that would not allow this patient to have another traditional open-heart surgery. Therefore, minimally invasive aortic and mitral valve replacement surgery was recommended. I was interested to find specific details about this procedure.

I found the article “Minimally invasive aortic valve replacement (MIAVR) – pros and cons of keyhole aortic surgery” that compares different approaches to heart surgeries and demonstrates the benefits of the latest approach that is minimally invasive (Kaczmarczyk, et al., 2015). This type of surgery has been evolving for the last twenty years and proves to safe, well-tolerated and efficient method. The authors explain that “minimally invasive” refers to any procedure not performed with a full sternotomy or cardiopulmonary bypass (Kaczmarczyk, et al., 2015).

There are two main types of MIAVR: partial sternotomy and intercoastal access. Lower hemisternotomy is the most popular partial sternotomy method. It provides excellent access to the heart and its vessels as well as stability of the rim of the upper limbs in postoperative period. Important advantages of this approach also include less surgical trauma, less postoperative bleeding and blood units transfused, faster recovery, shorter hospital stay and ICU stay, and less pain. It is however more technologically demanding and can often lead to failure if the surgeon does not have much experience.

Right anterior minithoracotomy scar vs. full sternotomy scar

References

Kaczmarczyk, M., SzaaÄski, P., Zembala, M., Filipiak, K., Karolak, W., Wojarski, J.,…Embala, M. (2015). Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery. Cardiac Surgery, 12(2), 103-110.