Wedge-Shaped Rib Detachment: A Simple Modification for Better Access to the Aortic Valve in Right Anterior Minimally Invasive Aortic Valve Replacement

Background/Objectives: Minimally invasive aortic valve replacement via right anterior thoracotomy (Mini-AVR) has been proven safe and effective. However, the restricted surgical field through this approach makes this surgery challenging and therefore limits its application. A simple modification of an exposure technique involving third-rib detachment from the sternum in a wedge shape allows for expansion of the surgical field to the left, facilitating surgical exposure and performance, which may shorten the learning curve for surgeons, and make this surgery applicable to patients with less favorable anatomy. Methods: This is a retrospective study. From 2019 to 2024, 176 patients aged 62.9 ± 17.5 years old underwent Mini-AVR via right anterior thoracotomy with third-rib detachment at our hospital in Vietnam. Results: A mechanical prosthesis was used in 98 patients (55.7%) and bioprosthesis in 78 patients (44.3%). Leftward and deep aorta position were seen in 57 (32.4%) and 18 (10.2%) patients, respectively. The aortic cross-clamp and bypass time were 78.69 ± 24.1 and 128.1 ± 26.3 min, respectively. Root enlargement was performed in 2 patients (1.1%). Conclusions: Wedge-shape detachment of the third rib from the sternum in Mini-AVR allows for expansion of the surgical field to the left, facilitating surgical exposure and performance, especially in patients with less favorable anatomy.