Related Experiment Video
Updated: Apr 15, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Minimally invasive aortic valve replacement: 12-year single center experience
Daniyar Gilmanov1, Marco Solinas1, Pier Andrea Farneti1
1Department of Adult Cardiac Surgery, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart hospital, Massa, MS 54100, Italy.
Background:
This study reports the single center experience on minimally invasive aortic valve replacement (MIAVR), performed through a right anterior minithoracotomy or ministernotomy (MS).
Methods:
Eight hundred and fifty-three patients, who underwent MIAVR from 2002 to 2014, were retrospectively analyzed. Survival was evaluated using the Kaplan-Meier method. The Cox multivariable proportional hazards regression model was developed to identify independent predictors of follow-up mortality.
Results:
Median age was 73.8, and 405 (47.5%) of patients were female. The overall 30-day mortality was 1.9%. Four hundred and forty-three (51.9%) and 368 (43.1%) patients received biological and sutureless prostheses, respectively. Median cardiopulmonary bypass time and aortic cross-clamping time were 108 and 75 minutes, respectively. Nineteen (2.2%) cases required conversion to full median sternotomy. Thirty-seven (4.3%) patients required re-exploration for bleeding. Perioperative stroke occurred in 15 (1.8%) patients, while transient ischemic attack occurred postoperative in 11 (1.3%). New onset atrial fibrillation was reported for 243 (28.5%) patients. After a median follow-up of 29.1 months (2,676.0 patient-years), survival rates at 1 and 5 years were 96%±1% and 80%±3%, respectively. Cox multivariable analysis showed that advanced age, history of cardiac arrhythmia, preoperative chronic renal failure, MS approach, prolonged mechanical ventilation and hospital stay as well as wound revision were associated with higher mortality.
Conclusions:
MIAVR via both approaches is safe and feasible with excellent outcomes, and is associated with low conversion rate and low perioperative morbidity. Long term survival is at least comparable to that reported for conventional sternotomy AVR.
Insights
Minimally invasive aortic valve replacement (MIAVR) is safe and effective, showing excellent patient outcomes and survival rates comparable to traditional methods. This approach offers a low conversion rate and reduced perioperative complications.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Aortic Valve Surgery
Background:
- Reports single-center experience with Minimally Invasive Aortic Valve Replacement (MIAVR).
- Procedures performed via right anterior minithoracotomy or ministernotomy (MS).
- Covers patient data from 2002 to 2014.
Purpose of the Study:
- Evaluate the safety and feasibility of MIAVR.
- Assess patient outcomes and survival rates.
- Identify predictors of mortality after MIAVR.
Main Methods:
- Retrospective analysis of 853 patients undergoing MIAVR.
- Kaplan-Meier method for survival evaluation.
- Cox multivariable regression to identify mortality predictors.
Main Results:
- Overall 30-day mortality was 1.9%.
- 1-year and 5-year survival rates were 96% and 80% respectively.
- Predictors of mortality included advanced age, renal failure, and MS approach.
Conclusions:
- MIAVR via minithoracotomy or MS is safe and feasible.
- Excellent outcomes with low conversion and morbidity rates.
- Long-term survival comparable to conventional sternotomy AVR.
