**6. Interventional therapeutic options**

#### **6.1 Surgical approach**

### *6.1.1 Conventional AVR*

The conventional approach to AVR consists of a mid-line incision and full sternotomy, which provide a complete and comfortable access to the heart. Since it was first successfully carried out by Harken and Starr in 1960 [26, 27], there has been a continuous innovation in prosthetic technology and surgical techniques. All these collective efforts have resulted in improvements in both operative and long-term results [17]. Regardless of surgical approach, elected AVR is the gold standard for the treatment of severe AS. Several studies have shown short- and long-term outcomes,

**37**

**Figure 3.**

*Right anterior thoracotomy through 2 or 3° intercostal space [17].*

*Current Management of Severe Aortic Stenosis in Intermediate Risk Patients*

as well as improved quality of life. Operative outcomes following AVR were still improving in the past decade. Wu et al. [28], determined the economic value of the additional life given to patients undergoing AVR, and concluded that AVR is cost-effective for all ages, and still worthwhile in octogenarian and nonagenarian

Minimally invasive surgery aims to minimize the degree of surgical intrusiveness. Currently, there are several surgical approaches. The partial sternotomy and right anterior minithoracotomy are the most frequently used incisions for a minimally invasive approach to the aortic valve. The choice of interventional approach depends on the patient's anatomy as observed in preoperative imaging

The "J" incision is the most widely used approach among the partial upper hemisternotomy approach (**Figure 2**). **Figure 3** shows the access view through right

*Partial upper hemisternotomy approach. Operative field distribution from surgeon view [17].*

*DOI: http://dx.doi.org/10.5772/intechopen.83422*

*6.1.2 Minimally invasive surgical (MIS) approaches*

patients.

**Figure 2.**

studies such as CT.

anterior minithoracotomy.

#### *Current Management of Severe Aortic Stenosis in Intermediate Risk Patients DOI: http://dx.doi.org/10.5772/intechopen.83422*

as well as improved quality of life. Operative outcomes following AVR were still improving in the past decade. Wu et al. [28], determined the economic value of the additional life given to patients undergoing AVR, and concluded that AVR is cost-effective for all ages, and still worthwhile in octogenarian and nonagenarian patients.
