Right Anterior Minithoracotomy Is an Alternative, Less Invasive Approach to Median Sternotomy during Aortic Valve Replacement for Patients with Low Left Ventricular Ejection Fraction

The concept of minimally invasive cardiac surgery has been put forward for more than decades and continued to develop. Recently, minimally invasive aortic valve surgery is established as a safe and effective treatment for various aortic valvular heart diseases and ascending aorta disorders. This study is aimed at analyzing the safety and effectiveness of aortic valve replacement (AVR) through right anterior minithoracotomy for the treatment of patients with low left ventricular ejection fraction (LVEF). Retrospective analyses of 43 cases with low LVEF undergoing AVR through median sternotomy and 43 cases with low LVEF undergoing AVR through right anterior minithoracotomy were performed. Extracorporeal circulation time and aortic cross-clamping time were longer in patients undergoing AVR through right anterior minithoracotomy than those in patients undergoing AVR through median sternotomy ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo><</a:mo> <a:mn>0.05</a:mn> </a:math> ). Patients undergoing AVR through right anterior minithoracotomy exhibited declines in the cardiac surgery intensive care unit (CSICU) stay, duration of mechanical ventilation, and the length of hospital stay than those undergoing AVR through median sternotomy ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo><</c:mo> <c:mn>0.05</c:mn> </c:math> ). The volumes of 24 h chest drainage were reduced in patients undergoing AVR through right anterior minithoracotomy compared with those undergoing AVR through median sternotomy ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo><</e:mo> <e:mn>0.05</e:mn> </e:math> ). The incidence rates of blood transfusion within 24 h and postoperative atrial fibrillation were lower in patients undergoing AVR through right anterior minithoracotomy than those in patients undergoing AVR through median sternotomy ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo><</g:mo> <g:mn>0.05</g:mn> </g:math> ). As for cardiac function, patients with right anterior minithoracotomy had decreased left ventricular end diastolic diameter (LVEDD) but increased LVEF and left ventricular fractional shortening (LVFS) when compared to median sternotomy ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo><</i:mo> <i:mn>0.05</i:mn> </i:math> ). With regard to inflammatory response, the serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) in patients with right anterior minithoracotomy were much lower than those in median sternotomy ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>P</k:mi> <k:mo><</k:mo> <k:mn>0.05</k:mn> </k:math> ). All these results indicate that right anterior minithoracotomy is an alternative, less invasive approach to median sternotomy during AVR for patients with low LVEF.