Right anterior minithoracotomy versus conventional aortic valve replacement: A propensity score matched study

Objective: Minimally invasive aortic valve surgery by way of a right anterior minithoracotomy has shown excellent results in terms of mortality, morbidities, and patient satisfaction. The aim of the present study was to compare minimally invasive aortic valve surgery by way of a right anterior minithoracotomy with conventional full sternotomy on early outcomes and midterm survival. Methods: A retrospective, observational, cohort study was undertaken of prospectively collected data from 637 consecutive patients undergoing isolated aortic valve surgery from January 2005 to July 2010. Of the 637 patients, 192 (30%) underwent minimally invasive aortic valve surgery by way of a right anterior minithoracotomy. Of these, 138 patients (right anterior minithoracotomy group) were matched to a control group (full sternotomy group) using propensity score analysis. Results: The baseline characteristics were similar in both groups. The overall in-hospital mortality was 0.7% (2/276), with no difference between the 2 groups. Minimally invasive aortic valve surgery by way of a right anterior minithoracotomy was associated with a lower incidence of postoperative atrial fibrillation (25 [18.1%] vs 41 [29.7%]; P = .003) and blood transfusions (26 [18.8%] vs 47 [34.1%]; P = .0006). In addition, patients in the right anterior minithoracotomy group had a shorter mechanical ventilation time (median, 6 vs 8 hours; P = .004) and postoperative length of stay (median, 5 vs 6 days; P = .02). The occurrence of stroke, renal failure, reexploration for bleeding, and wound infection was similar in both groups. At a median follow-up of 30 months (range, 17-54 months), survival was 96% +/- 2% vs 88% +/- 4% (P = .3). Conclusions: Right anterior minithoracotomy in patients undergoing isolated aortic valve surgery is associated with a lower incidence of postoperative atrial fibrillation and blood transfusion and shorter ventilation time and hospital length of stay. Prospective randomized trials are needed to confirm our data. (J Thorac Cardiovasc Surg 2013;145:1222-6)