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Updated: May 5, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Anterolateral approach for minimally invasive aortic valve replacement
Toshinori Totsugawa1, Masahiko Kuinose, Arudo Hiraoka
1Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan, toshinoritotsugawa@gmail.com.
An anterolateral thoracotomy (ALT) approach for minimally invasive aortic valve replacement (MIAVR) offers comparable outcomes to standard anterior thoracotomy (SAT), without sacrificing the right internal thoracic artery (RITA). This technique is effective even in patients with more severe conditions.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Right anterior thoracotomy is the standard for minimally invasive aortic valve replacement (MIAVR).
- This approach necessitates sacrificing the right internal thoracic artery (RITA), a potential drawback.
Purpose of the Study:
- To evaluate the efficacy of anterolateral thoracotomy (ALT) for MIAVR.
- To compare ALT outcomes with standard anterior thoracotomy (SAT) in MIAVR.
Main Methods:
- A comparative study involving 21 patients undergoing MIAVR via ALT and 59 patients via SAT.
- Perioperative outcomes were analyzed and compared between the two groups.
Main Results:
- Patients in the ALT group presented with more severe characteristics (age, aortic stenosis, Japan score).
- While operative times were similar, cardiopulmonary bypass and cross-clamping times were longer in the ALT group.
- No significant differences were observed in mortality, morbidity, or length of hospital stay between the groups.
Conclusions:
- Anterolateral thoracotomy (ALT) is a viable alternative for MIAVR.
- ALT avoids sacrifice of the RITA and offers cosmetic benefits.
- Similar clinical outcomes are achieved with ALT compared to SAT, even in higher-risk patients.
