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Updated: Jun 20, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Minimally invasive aortic valve replacement: late conversion to full sternotomy doubles operative time
Signe Foghsgaard1, Thomas Andersen Schmidt, Henrik K Kjaergard
1Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Abstract:
In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy. The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P < 0.001), with the intended full-sternotomy group having the shortest times. In conclusion, the mini-aortic valve replacement is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should be avoided by better preoperative evaluation of patients. In any event, the decision to extend a mini-sternotomy to a full sternotomy should be made early in the course of operation, before cardiopulmonary bypass is instituted.
Insights
Minimally invasive aortic valve replacement shows promise with zero 30-day mortality in selected patients. However, conversions to full sternotomy increased operative time, and extended procedures should be avoided.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Aortic Valve Repair
Background:
- Conventional aortic valve replacement involves a full sternotomy.
- Minimally invasive approaches aim to reduce surgical trauma and improve recovery.
- The efficacy and safety of minimally invasive aortic valve replacement (MIAVR) require further investigation.
Purpose of the Study:
- To evaluate the outcomes of MIAVR compared to conventional aortic valve replacement (AVR).
- To identify potential risks and benefits associated with MIAVR and extended procedures.
Main Methods:
- A descriptive prospective study comparing 98 patients undergoing MIAVR with 50 patients undergoing conventional AVR.
- Data collected included 30-day mortality, intraoperative conversions, operative times, and aortic cross-clamp/perfusion times.
Main Results:
- Zero 30-day mortality in the MIAVR group.
- 14% of MIAVR cases required intraoperative conversion to full sternotomy, doubling operative time.
- Intended full sternotomy group had significantly shorter aortic cross-clamp and perfusion times (P < 0.001).
- Four late noncardiac deaths occurred in the completed MIAVR group.
Conclusions:
- MIAVR is an excellent option for selected patients, offering a smaller scar.
- Randomized trials are needed to confirm MIAVR's advantages over conventional AVR.
- Extended mini-sternotomies are risky and should be avoided through better preoperative patient selection.
