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Updated: Jun 18, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Aortic valve replacement through a minimally invasive approach: preoperative planning, surgical technique, and
Andre Plass1, Hans Scheffel, Hatem Alkadhi
1Clinic for Cardiovascular Surgery, Zurich, Switzerland. andre.plass@usz.ch
Background:
This study reports the experiences of minimally invasive aortic valve replacement (MIAVR) through a right minithoracotomy performed in the past 26 months and describes the surgical technique, the learning curve, the complication rate, and the patient outcomes.
Methods:
From March 2006 to June 2008, 172 patients (113 men; mean age, 71 +/- 12 years) were scheduled for MIAVR (6- to 7-cm incision). Multislice computed tomography (MSCT) imaging was used for surgical planning in 139. Aortic cannulation/clamping were performed through a right-sided minithoracotomy and venous cannulation percutaneously through the groin. For obtaining optimal intercostal space (ICS) distances between the incision to the aorta and cardiac structures, 2- and 3-dimensional MSCT images were evaluated.
Results:
Operations were done in 171 patients. MIAVR was successfully performed in 160 (94%). Six patients underwent a conventional operation due to adhesions in 4, small diameter of aortic annulus (17 mm) in 1, and concomitant coronary artery disease in 1. One patient was considered nonoperable. After CT-planning choice of second ICS in 17%, third in 81%, and fourth in 1%. Five conversions to sternotomy were necessary. Intraoperative and postoperative complications occurred in 20 patients, including 1 death. Overall cardiopulmonary bypass was 158 +/- 41 min and cross-clamp time was 107 +/- 26 min. No blood products in 43% of MIAVR patients. Mean hospital length of stay was 10 +/- 3 days.
Conclusions:
MIAVR demonstrates excellent results. A considerably reduced complication rate in the course was noted. MSCT for preoperative planning is helpful for an improved mental preparation and for an accurate surgical strategy, including optimal access.
Insights
Minimally invasive aortic valve replacement (MIAVR) via right minithoracotomy shows excellent patient outcomes and a reduced complication rate. Multislice computed tomography (MSCT) aids surgical planning for optimal access and strategy.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Minimally invasive aortic valve replacement (MIAVR) offers an alternative to traditional sternotomy.
- This study evaluates MIAVR outcomes over a 26-month period.
Purpose of the Study:
- To report surgical technique, learning curve, complication rates, and patient outcomes for MIAVR.
- To assess the utility of multislice computed tomography (MSCT) in surgical planning for MIAVR.
Main Methods:
- 172 patients underwent MIAVR using a right minithoracotomy (6-7 cm incision).
- Multislice computed tomography (MSCT) was utilized for pre-operative planning in 139 patients.
- Aortic cannulation/clamping via minithoracotomy; venous cannulation percutaneously via the groin.
Main Results:
- MIAVR was successfully performed in 160 of 171 patients (94%).
- Five conversions to sternotomy were required; 20 patients experienced complications (1 death).
- Average cardiopulmonary bypass: 158 min; cross-clamp time: 107 min. 43% received no blood products; mean hospital stay: 10 days.
Conclusions:
- MIAVR demonstrates excellent clinical results with a reduced complication rate.
- Pre-operative MSCT planning improves surgical strategy and access.
- MIAVR is a safe and effective alternative for aortic valve replacement.
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