右肋間アプローチからの低侵襲大動脈弁置換

抄録

Minimally invasive aortic valve replacement (MIAVR) through right antero-lateral thoracotomy (ALT) has several advantages over traditional anterior chest approaches (right anterior thoracotomy, or partial sternotomy). First, ALT is less affected by anatomical variation of the position of the ascending aorta, second, concomitant mitral valve surgery is possible, and third, outcome in cosmesis is better. MIAVR can be done under direct vision and endoscopic assist. Longitudinal axillary incision and thoracotomy through the third inter-costal space is appropriate to directly look down the aortic valve. Endoscopic assist and tying down the sutures using a knot-pusher are mandatory. MIAVR can also be done totally endoscopically. Three dimensional endoscope and independent working ports for the right and left hand are helpful. Appropriate working space for the endoscopic surgery is obtained by antero-lateral approach. Standard valve can be used in endoscopic AVR, without using fastener devices.