Bentall–De Bono Procedure via Right Infra‐Axillary Mini‐Thoracotomy: Early and Midterm Outcomes of a Novel Minimally Invasive Approach

Background/Aim The Bentall–De Bono procedure stands as the primary treatment method for ascending aortic aneurysms together with their associated valve disorders. The procedure requires a complete sternotomy for execution, but this method causes multiple complications which decrease patient comfort. This exploratory study aimed to evaluate the feasibility and early‐to‐midterm outcomes of the Bentall procedure performed via a right infra‐axillary mini‐thoracotomy. Materials and Methods The researchers studied data from patients who received this surgical procedure during the period from January 2020 through December 2024. Preoperative data, surgical details, postoperative complications, and follow‐up outcomes were recorded. Changes in left ventricular dimensions were evaluated using a paired t ‐test; the learning curve was assessed by comparing the first and last twelve cases. Results A total of 24 patients were included. The mean age was 54.3 years, and 75% were male. The mean operation time was 248 min, cardiopulmonary bypass time was 142 min, and cross‐clamp time was 108 min. No sternotomy conversion was required. Thirty‐day mortality was zero, with a major complication rate of 4.2% and a minor complication rate of 33.3%. At a mean follow‐up of 26.5 months, 1‐ and 2‐year survival rates were 100%. Left ventricular end‐diastolic diameter decreased from 58.4 mm to 52.1 mm ( p < 0.001). At the final follow‐up, 83% of patients were in NYHA Class I. Conclusion Bentall–De Bono surgery via a right infra‐axillary mini‐thoracotomy appears to be feasible in selected patients. These preliminary findings suggest potentially low major complication rates and encouraging functional outcomes; however, given the retrospective design and limited sample size, results should be considered hypothesis‐generating. Comparative studies are needed to establish safety and efficacy relative to conventional sternotomy.