Single-center experience of minimally invasive ascending aortic surgery via right anterior mini-thoracotomy

BACKGROUND: The right anterior mini-thoracotomy (RAMT) has emerged as a well-established minimally invasive surgical approach in the field of cardiac surgery and is increasingly being utilized for valve-related interventions. However, high-quality clinical evidence supporting its application in ascending aorta surgery remains limited. This study aims to evaluate the safety and feasibility of ascending aortic operations performed via the RAMT approach. METHODS: A retrospective analysis was conducted on 41 patients who underwent ascending aortic surgery using the RAMT technique at the Cardiac Vascular Center of Northern Jiangsu Province People’s Hospital between June 2022 and June 2025. Patient baseline characteristics, perioperative outcomes, and follow-up data were systematically reviewed and analyzed. RESULTS: The study cohort comprised 41 patients aged 42 to 83 years. Among them, 27 patients underwent mini-Bentall or mini-Wheat procedures, while 24 underwent ascending aortic replacement. Operative duration ranged from 160.0 to 420.0 min. The median aortic cross-clamp time was 88.0 min (interquartile range [IQR]: 52.0–147.0), and the median cardiopulmonary bypass (CPB) time was 103.0 min (IQR: 68.0–158.0). The median length of intensive care unit (ICU) stay was 3.9 days (IQR: 2.0–7.8), with mechanical ventilation maintained for a median duration of 10.5 h (range: 5.2–22.7 h). Median postoperative drainage within the first 24 h was 220 mL. No deaths or major complications were observed during the follow-up period. CONCLUSIONS: Ascending aortic surgery performed via the RAMT approach demonstrates favorable safety and procedural feasibility, indicating its potential as a viable and promising minimally invasive technique suitable for wider clinical implementation.