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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.
Objective:
Right anterior thoracotomy is the most common approach of minimally invasive aortic valve replacement (MIAVR) via intercostal mini-thoracotomy. However, there are some disadvantages including sacrificing the right internal thoracic artery (RITA). The aim of the present study was to investigate the efficacy of anterolateral thoracotomy (ALT), which is similar to lateral thoracotomy used for minimally invasive mitral valve surgery, for MIAVR.
Methods:
From October 2012 to June 2013, 21 patients underwent MIAVR through ALT. Perioperative outcome of these patients was compared with those of 59 patients who underwent MIAVR via standard anterior thoracotomy (SAT) from May 2007 to September 2012.
Results:
Mean age, body surface area, annular size, the ratio of aortic stenosis, and Japan score (30 days mortality), in ALT group were significantly more severe than those in SAT group. There was no significant difference in operative time; however, cardiopulmonary bypass and cross-clamping times in ALT group were significantly longer than those in SAT group. Significant differences were not found in mortality, morbidity, intubation time, blood transfusion rate, intensive care unit stay, hospital stay, and echocardiographic data such as effective orifice area index between both groups.
Conclusions:
Anterolateral approach has several advantages including no need to sacrifice the RITA and cosmetic benefit in female patients, offering similar results as SAT even with more severe patient characteristics.
