Right anterior minithoracotomy for aortic valve replacement: 10-year experience of a single center

Objective: Minimally invasive aortic valve replacement (AVR) has been associated with several better outcomes over the standard full sternotomy approach. We revised our 10-year experience with right anterior minithoracotomy (RAMT) for AVR. Methods: Between 2004 and 2014, a total of 593 patients (310 men; median age: 73.8 years) underwent AVR via RAMT. Preoperatively, a mixed valve lesion was diagnosed in 55 (9.3%) patients; and pure aortic regurgitation in 86 (14.5%). Mean logistic EuroSCORE I (European system for cardiac operative risk evaluation) was 7.4 (median: 5.76). Results: In 302 (50.9%) patients, a sutureless or rapidly implantable biological prosthesis was used; in 23 (3.9%), a mechanical prosthesis; and in the remainder, a conventional biological prosthesis. A total of 113 (19.1%) patients had a small aortic annulus (<= 21 mm). Operative times averaged 80 (median: 74) minutes of crossclamping time, and 117 (107) minutes of perfusion time; these were significantly shorter with a sutureless prostheses, compared with a sutured prostheses: perfusion 99 versus 134 minutes, P < .0005; aortic crossclamping time: 64 versus 97 minutes, P < .0005. The mean (median) assisted ventilation time was 9.8 (6) hours; intensive care unit stay was 1.5 (1) days; hospital length of stay was 6.6 (6) days. Overall in-hospital mortality was 9 deaths (1.5%). At 31.5 months mean follow-up time (1531 cumulative patient-years), 94.8% survival was observed. Conclusions: Minimally invasive AVR is a safe procedure, with low perioperative morbidity, and low rates of reoperation and death at late follow-up. Excellent outcomes can be achieved with minimally invasive AVR via right anterior minithoracotomy. Sutureless prostheses facilitate minimally invasive AVR and are associated with reduced operative times.