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Updated: Jul 20, 2025
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Comparison of Minimally Invasive Valve Surgery: Hemi-Sternotomy vs. Right Anterolateral Thoracotomy Incision
Insights
Minimally invasive valve surgery using hemi-sternotomy or right anterolateral thoracotomy is safe and effective. Both approaches offer benefits for patients undergoing cardiac surgery, with surgeons able to master these techniques.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Minimally invasive valve surgery offers potential advantages over traditional sternotomy.
- Comparing different minimally invasive approaches is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare patient data from hemi-sternotomy and right anterolateral thoracotomy for minimally invasive valve surgery.
- To determine the safety and efficacy of these two distinct surgical incisions.
Main Methods:
- A retrospective study of 90 patients undergoing minimally invasive valve surgery between December 2019 and December 2022.
- Patients were divided into two groups: hemi-sternotomy (36 patients) and right anterolateral thoracotomy (54 patients).
- Data collected included patient demographics, surgical details, postoperative outcomes, and biomarker levels.
Main Results:
- Hemi-sternotomy group showed no deaths or major bleeding, while the thoracotomy group had one death and one femoral artery dissection.
- Significantly lower aortic clamp and cardiopulmonary bypass times were observed in the hemi-sternotomy group.
- Postoperative serum c-TNT and NT-PROBNP levels were higher on day two in the thoracotomy group but normalized by day five, with no significant intergroup differences.
Conclusions:
- Minimally invasive valve surgery, via either hemi-sternotomy or right anterolateral thoracotomy, is safe and effective post-learning curve.
- Both surgical techniques are beneficial for patients and readily mastered by surgeons.
- These findings support the continued advancement and adoption of minimally invasive cardiac surgery techniques.
Objective:
This study aims to compare patient data from two different surgical approaches for minimally invasive valve surgery: hemi-sternotomy and right anterolateral thoracotomy. The primary objective is to determine the safety and efficacy of both surgical incisions.
Methods:
Between December 2019 and December 2022, a total of 90 patients underwent minimally invasive valve surgery at our center. Among them, 36 patients received the hemi-sternotomy incision with an average age of 45.86 ± 14.83, and 54 patients received the right anterolateral thoracotomy with an average age of 56.77 ± 14.83 years. In the hemi-sternotomy group, 21 patients underwent aortic valve surgery, and 15 had mitral valve surgery, while in the right anterolateral thoracotomy group, 30 patients underwent aortic valve surgery, and 15 patients had mitral valve surgery.
Results:
No deaths or significant bleeding occurred in the hemi-sternotomy group. However, in the right anterolateral thoracotomy group, one patient died from continuous low cardiac output syndrome after surgery, and one patient suffered a femoral artery dissection. All other patients were discharged without complications. The aortic clamp time and the cardiopulmonary bypass time were significantly lower in the hemi-sternotomy group compared to the right anterolateral thoracotomy group. Conversely, the two groups had no significant differences in intubation time, 24-hour drainage, hospitalization time, and blood transfusion. On the second day after surgery, serum c-TNT and NT-PROBNP levels significantly increased in both groups, but they were significantly higher in the right anterolateral thoracotomy group than in the hemi-sternotomy group. However, on the fifth day after surgery, serum c-TNT and NT-PROBNP levels decreased significantly in both groups, with no significant differences between them.
Conclusions:
Minimally invasive valve surgery, whether performed with right anterolateral thoracotomy or hemi-sternotomy, is safe and effective after the learning curve. Patients can benefit from these advances in minimally invasive cardiac surgery, and surgeons can easily master these techniques.
