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Updated: Jul 27, 2025
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Aortic valve replacement through minithoracotomy. Results from the Peruvian experience
Josías C Ríos-Ortega1, Josué Sisniegas-Razón1, Roger Conde-Moncada1
1Departamento de Cirugía Cardiovascular, Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú. Departamento de Cirugía Cardiovascular Instituto Nacional Cardiovascular INCOR- EsSalud Lima Perú.
Objectives:
To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through mini-thoracotomy (MT).
Methods:
We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months.
Results:
Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001).
Conclusions:
AV replacement through MT is a safe procedure in our center for patients under 80 years.
Insights
Aortic valve replacement via mini-thoracotomy is safe for patients under 80, showing low major valve-related events and excellent functional outcomes at one year.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Valve Surgery
Background:
- Aortic valve replacement (AVR) is a critical procedure for managing aortic valve disease.
- Minimally invasive approaches like mini-thoracotomy (MT) are gaining traction for AVR.
- Assessing outcomes of AVR via MT is essential for patient selection and procedural refinement.
Purpose of the Study:
- To evaluate mortality, major valve-related events (MAVRE), and other complications after AVR using mini-thoracotomy (MT).
- To assess long-term functional status and safety of AVR through MT in a specific patient cohort.
Main Methods:
- Retrospective analysis of patients under 80 years undergoing AVR via MT between 2017-2021.
- Exclusion of patients with other surgical approaches, concomitant procedures, redo, or emergency surgeries.
- Data collection on MAVRE, mortality, and clinical variables at 30 days and 12-month follow-up.
Main Results:
- Fifty-four patients (median age 69.5 years, 65% female) were studied, primarily for aortic stenosis (65%).
- Low 30-day MAVRE rate (3.7%) with no in-hospital mortality; one stroke and one pacemaker implantation occurred.
- No reoperations for prosthesis dysfunction or endocarditis; sustained functional improvement (NYHA I/II) at 1-year follow-up.
Conclusions:
- Aortic valve replacement through mini-thoracotomy is a safe and effective procedure in selected patients under 80 years.
- The procedure demonstrates favorable short-term and mid-term outcomes regarding MAVRE and functional status.
- Mini-thoracotomy offers a viable minimally invasive option for aortic valve replacement in this patient demographic.
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