Right anterior mini-thoracotomy for isolated aortic valve replacement: An international and multicenter study

Right anterior mini thoracotomy (RAMT) is a sternum-sparing approach for aortic valve replacement (AVR). Single-center studies have found RAMT AVR to be safe; however, there is a paucity of large, multicenter, all-comer, and real-world data for this surgical strategy.

This retrospective study investigated the outcomes of isolated RAMT AVR at 6 centers in the United States, Canada, and Europe. Primary outcomes were death and disabling stroke within 30 days of surgery. Secondary outcomes included rate of conversion to sternotomy, prosthetic used, operative times, residual paravalvular leak, rate of permanent pacemaker (PPM) implantation, incidence of new onset postoperative atrial fibrillation (POAF), rate of blood transfusion, and intensive care unit and hospital length of stay.

Seven hundred and sixteen patients underwent isolated RAMT AVR between January 2012 and December 2024 across 6 centers. Four hundred and twenty-eight were male, and the mean age of the cohort was 68.1 ± 10.7 years. Six patients (0.8%) died and 3 (0.4%) experienced a disabling stroke. Thirteen patients (1.8%) required emergent reoperation to control bleeding, while 45 (6.3%) received transfused blood products. One hundred and thirty patients (18.2%) experienced POAF. The incidence of permanent pacemaker implantation after a sutured valve replacement was 2.51% (n = 18 patients). The median intensive care unit and hospital length of stay was 1 day and 5 days, respectively.

The findings of this study, the largest multicenter study on RAMT AVR reported to date, suggest that this is a safe operation associated with excellent outcomes.