Zugangswege zum minimalinvasiven Aortenklappenersatz

In addition to the classical cardiac surgical access via a full sternotomy, in recent years reduced and minimally invasive surgical approaches have become established and in some centers these have almost completely replaced the conventional access to aortic valve surgery. While partial sternotomy is not inferior to classical sternotomy, even with conventional techniques, technical developments in aortic valve prostheses, automated suturing and fixation systems and peripheral cannulation techniques for the heart-lung machine have had a significant impact on the feasibility of the minimally invasive access route, especially for thoracic access routes. A direct comparison of upper hemisternotomy with the anterolateral access at our center shows a lower mortality, lower complication rates and shorter perfusion times. The penetration and acceptance of this procedure are also greater. The further development of the thoracotomy access, in the sense of an endoscopic port access operation, seems most likely to have significant advantages for suitable patients. Patients primarily benefit from minimally invasive procedures, particularly from the lower invasiveness of the thoracic cage and soft tissue coverage as well as smaller scars. This leads not only to cosmetic advantages but also to improved thoracic stability and therefore to a faster mobilization and rehabilitation.