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Updated: Jan 10, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Comparison of Right Ventricular Function Between Full Sternotomy Aortic Valve Replacement, Mini-Sternotomy Aortic
Yoshihisa Morita1, Taro Kariya2, Linda Sundt1
1Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Background:
The importance of right ventricular (RV) function assessment has been a hot topic in cardiac surgery, and perioperative RV function is known to determine the outcome of cardiac surgery. However, RV echocardiographic assessment is challenging due to RV geometric changes. Currently, a 3D-derived RV assessment is recommended. Previous studies have shown that RV function is reduced more in surgical aortic valve replacement (SAVR) than in transcatheter aortic valve replacement (TAVR); however, RV assessment in these studies was mostly performed using 2-dimensional echocardiography. Moreover, very few studies have assessed the difference in RV function between full sternotomy (full-SAVR) and mini-sternotomy AVR (mini-SAVR). This study assessed RV function in three types of AVR using 3D RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (RVFAC).
Methods:
This is a prospective, observational study at a university hospital setting. Participants are adult patients who underwent TAVR, mini-SAVR, and full-SAVR.
Measurements And Main Results:
Sixty-seven patients were enrolled in this study (22, 22, and 23 patients in the TAVR, mini-SAVR, and full-SAVR groups, respectively). The % change (pre- and post-procedure) in 3D RVEF, RVFAC, and TPASE in TAVR, mini-SAVR, and full-SAVR were as follows: 3D RVEF: 4.51 ± 10.89 (TAVR), -13.67 ± 19.81 (mini-SAVR), and -8.36 ± 18.24 (full-SAVR) (p = 0.003).
Rvfac:
4.35 ± 12.33 (TAVR), -8.28 ± 23.88 (mini-SAVR), and -9.49 ± 20.92 (full-SAVR) (p < 0.001).
Tapse:
10.46 ± 24.17 (TAVR), -22.14 ± 32.48 (mini-SAVR), and -32.48 ± 31.81 (full-SAVR) (p < 0.001). Comparisons were adjusted for age, gender, central venous pressure, catecholamine amount, and each preoperative RV index.
Conclusion:
There was significantly more worsening of 3D RVEF, RVFAC and TAPSE after full-SAVR and mini-SAVR than after TAVR.
