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Updated: Mar 5, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Minimally Invasive Aortic Valve Replacement via Right Anterior Minithoracotomy and Central Aortic Cannulation: A
Daniel M Bethencourt1, Jennifer Le, Gabriela Rodriguez
1From the *MemorialCare Heart & Vascular Institute at Long Beach Memorial, Long Beach, CA USA; †Orange Coast Memorial, Fountain Valley, CA USA; ‡University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA USA; and §Division of Cardiology, University of California Irvine, CA USA.
Objective:
This study reports the evolution of a minimally invasive aortic valve replacement (mini-AVR) technique that uses a right anterior minithoracotomy approach with central cannulation, for a 13-year period. This technique has become our standard approach for isolated primary AVR in nearly all patients.
Methods:
This observational study evaluated perioperative clinical outcomes of patients 18 years or older who underwent mini-AVR from November 2003 to June 2015.
Results:
The mini-AVR technique was used in 202 patients during two periods of 2003 to 2009 (n = 65, "early") and 2010 to 2015 (n = 137, "late"). The mean ± SD age was 72.5 ± 12.9 years and 60% were male. Demographic parameters were statistically similar between the study periods, except for increased body weight in the later period (75.3 ± 14.7 vs 80.9 ± 20.8 kg, P = 0.03). The mean cardiopulmonary bypass and aortic cross-clamp times were significantly different by each year and Bonferroni adjustment, with significant decreases in cardiopulmonary bypass and aortic cross-clamp times beginning 2006. Compared with the early study period, late study period patients were more often extubated intraoperatively (52% vs 12%, P < 0.001), had less frequent prolonged ventilator use postoperatively (6% vs 16%, P = 0.018), required fewer blood transfusions (mean, 2.0 ± 2.3 U vs 3.6 ± 3.0 U; P = 0.011), and had shorter postoperative stay (6.3 ± 4.5 days vs 8.0 ± 5.9 days, P = 0.026). Numerically, fewer postoperative strokes (1% vs 6%, P = 0.09) and fewer reoperations for bleeding (3% vs 6%, P = 0.3) occurred in the late period. In-hospital mortality did not differ (1/65 early vs 3/137 late).
Conclusions:
Overall mini-AVR intraoperative and postoperative clinical outcomes improved for this 13-year experience.
