Selection of patients for aortic valve replacement via right anterior minithoracotomy based on different CT criteria

Objective. To determine the optimal patient selection criteria for aortic valve (AV) replacement via right anterior mini-thoracotomy based on literature data and single-center experience. Material and methods. From January 2024 to January 2025, 13 patients with AV disease were consecutively included in this study. All patients underwent preoperative chest CT with subsequent assessment of anatomical CT criteria as a part of surgical approach planning. Results. There was one in-hospital fatal outcome. Mean CPB and aortic occlusion time was 124 [109; 146] and 82 [72; 109] min, respectively. AV defect correction was satisfactory in all cases. Mean pressure gradient was 10.5 [8.7; 13.5] mm Hg. There were no cases of paraprosthetic and significant transprosthetic regurgitation. Considering literature data and our own experience, we determined CT criteria for open AV surgery through anterior right mini-thoracotomy. Conclusion. Anterior right minithoracotomy is a promising alternative to longitudinal or partial sternotomy for surgical correction of aortic valve disease. For preoperative preparation and patient selection, it is preferable to take into account anatomical CT criteria: the angle between the right edge of the sternum and medial aortic wall at the level of pulmonary artery bifurcation >145°, depth of aorta on horizontal slice at the bifurcation of pulmonary artery from the skin to the posterior aortic wall <10 cm, depth of aortic valve on axillary slice, distance from the intended skin incision site to the plane of aortic annulus <16 cm, width of intercostal space at the site of surgical access >1 cm, diameter of ascending aorta <40 mm.