Ultra fast-track trans-axillary mini-aortic valve replacement

Despite minimally-invasive aortic valve replacement (MI-AVR) having gained interest within the cardiac surgeons’ community, patient requests for interventions associated with minimized trauma and faster recovery often remains unfulfilled (1). In our center, we believe that a MI-AVR program (2) may benefit from a multidisciplinary approach that combines reduced incisions with an increasing use of rapid deployment valves (RD), minimal invasive extracorporeal circulation system (MiECC) (3) and fast-track anesthetic (UFT) management. Our experience with the MI trans-axillary direct approach in mitral valve surgery (MVS) (4) led us to consider that the aortic valve could be nicely exposed from the same approach. As a result, we recently initiated the use of trans-axillary incisions for MI-AVR in selected patients. In this setting, RD valves may help with reducing technical complexity and operative times. The aim of this video is to share our approach in a step-by-step fashion.