Anterior Right Thoracotomy for Rapid-Deployment Aortic Valve Replacement.

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Aortic Valve Replacement

Background:

• Anterior right thoracotomy (ART) is a safe and feasible minimally invasive approach for aortic valve replacement.
• Limited surgical community acceptance of ART necessitates innovative solutions.
• Rapid-deployment aortic valves simplify surgical techniques and reduce operative times.

Purpose of the Study:

• To assess the safety and feasibility of combining ART with rapid-deployment aortic valves.
• To evaluate the outcomes of this combined approach in a single-center experience.

Main Methods:

• Retrospective analysis of 165 patients undergoing aortic valve replacement via ART using the Edwards Intuity Elite valve system (2011-2018).
• Data collected prospectively in a single-center registry.
• Valve outcomes analyzed according to current guidelines.

Main Results:

• The study included 165 patients (age 73 ± 9 years, 49% female) with a median STS-PROM II score of 1.6.
• Median cardiopulmonary bypass and aortic cross-clamp times were 114 and 80 minutes, respectively.
• Thirty-day and in-hospital mortality was 0.6%; 3% experienced postoperative neurologic events (1 major deficit).
• Intermediate and long-term survival rates were excellent: 99% at 6 months, 98% at 1 year, and 93% at 3 years.

Conclusions:

• Implantation of the Edwards Intuity valve system via ART is safe, feasible, and reproducible.
• This single-center experience demonstrates excellent results compared to contemporary surgical and transcatheter aortic valve replacements.