Objective

Aortic valve replacement (AVR) through right anterior minithoracotomy (MT) is increasingly performed, becoming a feasible and popular alternative to conventional full sternotomy (FS). AVR through right anterior MT has been proved to have outstanding outcomes, minimizing patient trauma, improving recovery, and reducing hospital expenditures. We report our experience with the first 200 case of AVR through right anterior MT.

Methods

From August 2012 to September 2015, 200 elective consecutive patients were operated on AVR through right anterior MT (4- to 6-cm incision) by a single surgeon. The population had an average age of 69.9 ± 11.9 years (range, 31 to 86), contained 108 (54%) men, and revealed a mean EuroSCORE II of 10.4 ± 7.2. Indication for AVR included stenosis in 90 patients (45%), mixed lesions in 82 (41%), and predominant regurgitation in 28 (14%). Multislice computed tomography was used for surgical planning.

Results

Hospital mortality accounted for 4 (2%) patients, 2 (1%) patients required a conversion to full sternotomy and other 13 (6.5%) a re-exploration for bleeding. Cardiopulmonary bypass (CPB) was 108 ± 25 min and cross-clamp (ACC) time was 74 ± 14 min. Although not significant, a decrease in CPB time was observed with surgeon experience (R2 = 0.2, p = 0.255). Postoperative stroke was registered in 1 (0.5%) patients and atrial fibrillation in 55 (28%). Mean hospital length of stay was 11.8 ± 84 days.

Conclusion

Our initial experience on AVR through anterior MT demonstrated excellent results with reduced complication rate.