Comparing Aortic Valve Replacement through Right Anterolateral Thoracotomy with Median Sternotomy

Background: Aortic Valve Replacement (AVR) is usually done through median sternotomy. The present study aimed to compare the right anterolateral thoracotomy and median sternotomy approaches for AVR. Methods: The present prospective study was conducted on 60 patients who had aortic valve disease and were subjected to AVR. Thirty patients underwent aortic valve replacement via right anterolateral thoracotomy (study group) and thirty patients via median sternotomy (control group). Statistical analysis was done using Mann Whitney U test and Fischer's Exact test. Statistical Package SPSS - 17 was used for data analysis. Results: The mean length of the incision was 18.7 +/- 1.8 cm in the patients who had undergone AVR through median sternotomy, while 7.8 +/- 0.9 cm in the study group patients. Besides, the mean bypass time was 121.8 +/- 18.6 minutes for the patients who had undergone AVR through median sternotomy, while 122.1 +/- 20.8 minutes for the study group. In addition, the mean aortic cross clamp time was 67.7 +/- 13.4 minutes for the patients who had undergone AVR through median sternotomy, while 68.0 +/- 8.9 minutes for the study group. The mean operating time was 181.6 +/- 31.5 minutes for the patients who had undergone AVR through median sternotomy, while 190.8 +/- 29.8 minutes for the study group. Patient satisfaction with respect to cosmesis was higher in the study group. Only 50% of the patients who had undergone AVR through median sternotomy in comparison to 73.3% of those in the study group were satisfied with the cosmesis. Conclusions: The right anterolateral thoracotomy approach for aortic valve replacement proved to be easy to perform whilst maintaining the maximum security for the patients. Besides its better cosmetic result especially in female patients, this approach proved to have several advantages.