Minimally Invasive Autopericardial Neocuspidization with Thoracoscopic Pericardial Harvesting

Aim: To assess the results of autopericardial neocuspidization of the aortic valve through J-shaped ministernotomy with thoracoscopic pericardial harvesting compared to full median sternotomy.

Methods: 64 medical records of patients were retrospectively reviewed. 20 patients who underwent AVNeo through J-shaped ministernotomy with thoracoscopic pericardial harvesting were assigned to Group 1. 44 patients who underwent classical AVNeo procedure were assigned to Group 2. Both groups were similar in terms of comorbidities and concomitant cardiac diseases. In Group 1, fourteen patients (70%) received femoral vein-femoral artery cardiopulmonary bypass (CPB) and six patients (30%) – femoral vein-aorta CPB. Pericardium harvesting was performed on the dry heart using port-access. The mean harvesting time was 29.2±4.2 minutes. The size of the collected pericardium did not differ between the two groups. J-shaped ministernotomy was performed on the third or the fourth intercostal space based on MSCT imaging.

Results: J-shaped ministernotomy was associated with increased mean CPB time and aortic cross-clamp time (175.5±11.6 min and 102.5±7.8 min in Group 1, p>0.001 vs. 114.4±40.6 min and 84.4±19.9 min in Group 2, p>0.001, respectively). Our findings showed less blood loss with J-shaped ministernotomy (576±114.7 mL in Group 1 and 763.6±446.7 mL in Group 2, p=0.027). All patients in Group 1 were successfully discharged from the hospital, but two patients died in Group 2 (4.5%). The duration of postoperative mechanical ventilation was significantly less in Group 1 (2.85±2.3 hours) compared to Group 2 (5.18±3.9 hours, p>0.001). Group 1 patients reported less intense pain on the VAS scale (p>0.001). The length of in-hospital stay after surgery was significantly shorter in Group 1 compared to Group (7.1±3 days vs. 13.9±5.5 days, respectively, p>0.001). Both surgical approaches did not differ in terms of the effectiveness.

Conclusion: Thoracoscopic pericardial harvesting allows using less traumatic approach to perform AVNeo procedure. Minimally invasive autopericardial neocuspidization of the aortic valve is a safe and effective procedure.

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