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Updated: Jul 5, 2026

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Aortic valve stenosis and regurgitation: an overview of management
1Center for Aortic Surgery, Marfan and Connective Tissue Disorder Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. svenssl@ccf.org
Insights
Aortic valve disease correction significantly improves quality and duration of life. Newer minimally invasive techniques and repair options offer excellent outcomes, increasing awareness of these advanced cardiovascular treatments.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Minimally Invasive Cardiac Surgery
Background:
- Aortic valve disease correction offers significant improvements in quality and duration of life.
- Aortic valve stenosis is prevalent, especially in the elderly, yet undertreated despite high survival rates with minimally invasive approaches.
- Percutaneous transfemoral and transapical techniques are viable alternatives for high-risk or inoperable patients.
Purpose of the Study:
- To highlight the advancements in aortic valve disease treatment.
- To inform patients and physicians about newer therapeutic options and their outcomes.
Main Methods:
- Review of minimally invasive surgical approaches including the J incision.
- Evaluation of percutaneous transfemoral and transapical interventions.
- Assessment of aortic valve repair strategies based on patient anatomy (CLASS criteria).
Main Results:
- Minimally invasive J incision approach shows 99% operative survival.
- Aortic valve repair in younger patients with specific valve types and regurgitation yields excellent results.
- Over 90% freedom from reoperation at 10 years is achievable with appropriate patient selection and approach.
Conclusions:
- The scope of aortic valve disease procedures has expanded significantly.
- Patients and physicians must be aware of and consider these advanced treatment options.
- Personalized treatment strategies based on detailed anatomical assessment are crucial for optimal outcomes.
Unlabelled:
There are few cardiovascular disease entities that have as an impressive contribution to improved quality and duration of life as aortic valve disease correction. Although aortic valve stenosis is fairly common, particularly in elderly patients, between one third and two thirds go untreated, despite operative survival rates with the minimal invasive J incision approach of 99%. For those patients with high risk co-morbidity or technical inoperable reasons, the percutaneous transfemoral or transapical approaches are now available with good initial
Results:
For younger patients with tricuspid valves or bicuspid valves and aortic regurgitation, aortic valve repair should be the first choice procedure and with careful selection of the appropriate approach based on analysis of the patients CLASS (Commissure, Leaflet, Annulus, Sinotubular junction, and Sinuses) anatomy. Excellent results can be obtained with better than 90% freedom from reoperation at 10 years. The scope of procedures for aortic valve disease has increased markedly over the last 10 years and patients and cardiovascular physicians need to be aware of these newer options.
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