Right Anterior versus Right Transaxillary Access for Minimally Invasive Aortic Valve Replacement: A Propensity...

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Right anterior thoracotomy (RAT-AVR) is an established sternum-sparing technique for minimally invasive aortic valve replacement (MICS-AVR).
• Transaxillary access, termed Minimally Invasive Cardiac LATeral Surgery (MICLATS-AVR), is an innovative advancement in sternum-sparing MICS-AVR.

Purpose of the Study:

• To compare procedural and clinical outcomes of MICLATS-AVR with RAT-AVR.
• To evaluate the safety and feasibility of MICLATS-AVR as an alternative MICS-AVR approach.

Main Methods:

• Retrospective study of 918 MICS-AVR patients (2014-2022), divided into RAT-AVR (n=492) and MICLATS-AVR (n=426) groups.
• Propensity score matching created 359 pairs for comparative analysis of procedural data, morbidity, and mortality.

Main Results:

• No significant differences in major adverse cardio-cerebral events (MACCE) between MICLATS-AVR and RAT-AVR groups.
• Comparable skin-to-skin and aortic cross-clamp times, despite longer cardiopulmonary bypass in MICLATS-AVR.
• Shorter hospital stay (9.2 vs. 9.7 days) and significantly lower rates of postoperative impaired wound healing (3.9% vs. 11.7%) in the MICLATS-AVR group.

Conclusions:

• MICLATS-AVR is a safe and time-efficient alternative to RAT-AVR for MICS-AVR, with comparable MACCE rates.
• MICLATS-AVR offers benefits of shorter hospital stay and reduced wound complications.
• This sternum- and bone-sparing approach preserves the right mammary artery and facilitates combined procedures.