Minimally invasive aortic valve procedures through a hemi-sternotomy or a right anterior mini-thoracotomy have gained popularity over the last several years. Totally endoscopic aortic valve replacement (TEAVR) is an innovative and a less invasive (incision-wise) surgical aortic valve replacement (SAVR) technique. The operative steps of TEAVR have been reported previously from our group. Mitral regurgitation (MR) frequently accompanies aortic valve disease, and sometimes requires repair. Can totally endoscopic surgery be applied in such cases?
We present the surgical technique of a totally endoscopic approach to aortic valve replacement and concomitant mitral valve repair for primary or secondary MR. We used the aortotomy incision and avoided an atriotomy that would result in a prohibited increase in cross-clamp (XC) and cardiopulmonary bypass (CPB) times and an elevation in mortality and morbidity rates. Neochords (artificial chordae tendineae) were used for the repair of primary MR and the edge-to-edge approach was used for the repair of secondary MR.
Totally endoscopic aortic valve replacement and concomitant mitral valve repair can be performed transaortically with reasonable XC and CPB times, and excellent short-term results.