Key result
Right anterior thoracotomy minimally invasive aortic valve replacement was associated with longer cardiopulmonary bypass time (130.24 vs 117.75 minutes, P=0.012) but comparable in-hospital mortality.
Why the study?
The study aimed to compare the early postoperative outcomes of right anterior thoracotomy minimally invasive aortic valve replacement with median full sternotomy aortic valve replacement to identify the potential benefits or drawbacks of each approach.
Does right anterior thoracotomy minimally invasive aortic valve replacement improve early postoperative outcomes compared to median full sternotomy in patients requiring isolated aortic valve replacement?
Cohort (n=476)
No
Does right anterior thoracotomy minimally invasive aortic valve replacement improve early postoperative outcomes compared to median full sternotomy in patients requiring isolated aortic valve replacement?
Absolute Event Rate: 130.24% vs 117.75%
p-value: p=0.012
Minimally invasive right anterior thoracotomy for aortic valve replacement is a safe alternative to full sternotomy, offering reduced blood loss and shorter hospitalization despite longer operative times.
May support selective use despite longer bypass times; leaves open randomized comparisons for broader adoption.
INTRODUCTION: This study aimed to compare the early postoperative outcomes of right anterior thoracotomy minimally invasive aortic valve replacement (RAT-MIAVR) surgery with those of median full sternotomy aortic valve replacement (MFS-AVR) approach with the goal of identifying potential benefits or drawbacks of each technique. METHODS: This retrospective, observational, cohort study included 476 patients who underwent RAT-MIAVR or MFS-AVR in our hospital from January 2015 to January 2023. Of these, 107 patients (22.5%) underwent RAT-MIAVR, and 369 patients (77.5%) underwent MFS-AVR. Propensity score matching was used to minimize selection bias, resulting in 95 patients per group for analysis. RESULTS: After propensity matching, two groups were comparable in preoperative characteristics. RAT-MIAVR group showed longer cardiopulmonary bypass time (130.24 ± 31.15 vs. 117.75 ± 36.29 minutes, P=0.012), aortic cross-clamping time (76.44 ± 18.00 vs. 68.49 ± 19.64 minutes, P=0.004), and longer operative time than MFS-AVR group (358.47 ± 67.11 minutes vs. 322.42 ± 63.84 minutes, P=0.000). RAT-MIAVR was associated with decreased hospitalization time after surgery, lower postoperative blood loss and drainage fluid, a reduced incidence of mediastinitis, increased left ventricular ejection fraction, and lower pacemaker use compared to MFS-AVR. However, there was no significant difference in the incidence of major complications and in-hospital mortality between the two groups. CONCLUSION: RAT-MIAVR is a feasible and safe alternative procedure to MFS-AVR, with comparable in-hospital mortality and early follow-up. This minimally invasive approach may be a suitable option for patients requiring isolated aortic valve replacement.
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Bokha et al. (2024) conducted a cohort in Isolated aortic valve replacement (n=476). Right anterior thoracotomy minimally invasive aortic valve replacement (RAT-MIAVR) vs. Median full sternotomy aortic valve replacement (MFS-AVR) was evaluated on Cardiopulmonary bypass time (minutes) (p=0.012). Right anterior thoracotomy minimally invasive aortic valve replacement was associated with longer cardiopulmonary bypass time (130.24 vs 117.75 minutes, P=0.012) but comparable in-hospital mortality.
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