Minithoracotomy Versus Sternotomy for Aortic Valve Replacement: Outcomes from a Latin American Comparative Study

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Aortic valve replacement (AVR) is a critical procedure for severe aortic valve disease.
• Comparing surgical approaches like full sternotomy (FS) and mini-thoracotomy (MT) is essential for optimizing patient outcomes.
• Evaluating the efficacy and safety of minimally invasive cardiac surgery (MICS) in diverse healthcare settings is crucial.

Purpose of the Study:

• To compare the outcomes of isolated aortic valve replacement (AVR) using mini-thoracotomy (MT) versus full sternotomy (FS).
• To assess all-cause mortality and other key clinical variables based on the VARC 3 Consortium criteria.
• To determine the feasibility of implementing MICS programs in middle-income countries.

Main Methods:

• A retrospective study was conducted from January 2017 to December 2024 across two referral centers in Peru.
• Data from 142 patients undergoing isolated AVR via MT and 772 patients via FS were analyzed.
• Unmatched analysis and Propensity Score Matching (PSM) were employed to compare patient groups.

Main Results:

• In unmatched analysis, operative mortality was similar (MT: 2.1% vs. FS: 1.6%).
• Post-matching analysis revealed comparable operative mortality (MT: 0.9% vs. FS: 2.8%), stroke rates, and five-year survival estimates between MT and FS groups.
• While pacemaker insertion and post-operative atrial fibrillation (POAF) were more frequent in the MT group in unmatched analysis, these differences diminished after PSM.

Conclusions:

• Isolated AVR via MT or FS demonstrates similar operative and long-term mortality rates.
• Minimally invasive cardiac surgery (MICS) can be successfully implemented with favorable results, even in middle-income countries.
• The study supports the use of MT as a viable alternative to FS for AVR, with comparable safety and efficacy profiles.