Consensus statement on aortic valve replacement via an anterior right minithoracotomy in the UK healthcare setting
Joseph Zacharias,
Massimo Caputo,
Ranjit Deshpande,
M Yousuf Salmasi,
Hunaid A Vohra,
Toufan Bahrami,
Inderpaul Birdi,
Fatemazahra Mohamed,
Monica Shehata,
Bardia Bahrami,
Vinayak Bapat
Affiliations
Joseph Zacharias
2 Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
Massimo Caputo
4 National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
Ranjit Deshpande
Kings College Hospital
M Yousuf Salmasi
Surgery and Cancer, Imperial College London, London, UK
Hunaid A Vohra
Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
Toufan Bahrami
Cardiac Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
Inderpaul Birdi
Department of Cardiac Surgery, Essex Cardiothoracic Centre, Basildon, UK
Fatemazahra Mohamed
Imperial College London, London, UK
Monica Shehata
Royal Brompton and Harefield Hospitals, London, UK
Bardia Bahrami
Royal Brompton and Harefield Hospitals, London, UK
Vinayak Bapat
Cardiovascular Directorate, Guy’s & St Thomas’ Hospitals NHS Foundation Trust, London, UK
The wide uptake of anterior right thoracotomy (ART) as an approach for aortic valve replacement (AVR) has been limited despite initial reports of its use in 1993. Compared with median sternotomy, and even ministernotomy, ART is considered to be less traumatic to the chest wall and to help facilitate quicker patient recovery. In this statement, a consensus agreement is outlined that describes the potential benefits of the ART AVR. The technical considerations that require specific attention are described and the initiation of an ART programme at a UK centre is recommended through simulation and/or use of specialist instruments in conventional cases. The use of soft tissue retractors, peripheral cannulation, modified aortic clamping and the use of intraoperative adjuncts, such as sutureless valves and/or automated knot fasteners, are important to consider in order to circumvent the challenges of minimal the altered exposure via an ART.A coordinated team-based approach that encourages ownership of the programme by team members is critical. A designated proctor/mentor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider.
