RIGHT TRANS-AXILLARY ENDOSCOPIC AORTIC VALVE REPLACEMENT WITH RAM DEVICE:

Author Block: Francesca Chiaramonti, Giovanni Concistrè, Silvia Di Sibio, Rosa Giusti, Marco Solinas.
Heart Hospital G.Pasquinucci FTGM, Massa, Italy.

Abstract:
BACKGROUND - Totally Endoscopic Cardiac Surgery offers several advantages compared with conventional open-heart surgery and even other minimally invasive approaches. Performing this surgery requires the use of several techniques and technologies that employ the latest innovations in instrumentation and advances in technology in this field. One of the most recent available tools is the RAM® device. METHODS - We have developed a surgical setting that enables us to easily performe a totally endoscopic AVR using the RAM® device. A small thoracotomy (work port) is performed at the third intercostal space on the anterior axillary line. Two ports are placed at the second and fourth/fifth intercostal spaces respectively for the endoscopic probe, the ventricular vent and the CO2 delivery probe. Finally, the Chitwood clamp is placed posteriorly in the third intercostal space. The RAM® device is an automated, dual-curved needle annular suturing device that can place a horizontal mattress stitch with just one squeeze. The sutures are then passed through the prosthetic ring using the SEW-EASY prosthetic suturing system. Finally, the sutures are tied with the cor-knot.
RESULTS - Using this setup, we have observed that RAM® sutures positioning is straightforward in all types of thoracic anatomy and aortic valve pathologies, making the procedure faster and easier.
CONCLUSIONS - A totally endoscopic AVR through a trans-axillary minithoracotomy in the third intercostal space using the RAM® device could be considered the perfect solution for a surgical aortic valve replacement when a sutured prosthesis is used. The configuration described, combined with the use of advanced technology, expands the feasibility of a totally endoscopic approach to aortic valve replacement, making it a simpler and quicker procedure