Outcomes of reoperative aortic valve replacement via right mini-thoracotomy versus median sternotomy

The study aim was to determine the safety and efficacy of a minimally invasive right mini-thoracotomy for aortic valve replacement (AVR) in patients who had undergone previous median sternotomy.

Between January 2005 and December 2011, a total of 3,603 consecutive cases was retrospectively reviewed to identify patients with previous median sternotomy who subsequently underwent AVR. The outcomes of patients having minimally invasive surgery were compared with those in whom a median sternotomy approach had been employed.

Among 77 patients identified, 36 (47%) underwent a minimally invasive approach, and 41 (53%) had a median sternotomy. The mean age of the minimally invasive group (33 males, three females) was 75.3 +/- 9.0 years, and that of the median sternotomy group (33 males, eight females) was 68.2 +/- 13.6 years (p = 0.009). The minimally invasive group had more prior sternotomy for coronary artery bypass graft surgery (86% versus 59%, p = 0.007), and fewer for prior valve surgery (33% versus 59%, p = 0.02). In-hospital mortality was zero for the minimally invasive cohort versus four (10%) in the median sternotomy group (p = 0.08); composite postoperative complications occurred in six (17%) versus 19 (46%) (p = 0.005) of these two groups, respectively. The median intensive care unit and total hospital length of stay were 48 h [interquartile range (IQR) 41-97] versus 69 h [IQR 45-174] (p = 0.03), and seven days [IQR 5-10] versus 9 days [IQR 7-15] (p = 0.03) for the minimally invasive and median sternotomy group, respectively.

Minimally invasive AVR via a right mini-thoracotomy in patients with previous cardiac surgery can be performed safely, and is associated with shorter intensive care unit and total hospital stays, a lower morbidity, and a trend towards lower mortality.