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Updated: Jun 18, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Surgical aortic valve replacement with Y-incision aortic annular enlargement provided better hemodynamics than
Katelyn Monaghan1, Marc Titsworth1, Divyaam Satija1
1Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
Objective:
We aimed to examine early outcomes of surgical aortic valve replacement (SAVR) with Y-incision aortic annular enlargement (Y-AAE) versus transcatheter AVR (TAVR) in native aortic valve stenosis.
Methods:
From August 2020 to March 2024, 362 patients with severe native aortic valve stenosis underwent SAVR + Y-AAE with bioprosthetic valves (n = 70) or TAVR (n = 292) with ejection fraction ≥50%, Society of Thoracic Surgeons predicted risk of mortality score ≤8, and minimal aortic annular diameter ≤25 mm by computed tomography. Nearest-neighbor 1:3 propensity score matching was conducted across all preoperative variables.
Results:
The minimal aortic annular diameter by CT was 22 mm (IQR, 20, 23 mm) in the TAVR group and 21 mm (IQR, 19, 23 mm) in the SAVR + Y-AAE group. The TAVR group had median implanted valve sizes of Edwards LifeSciences Sapien 26 mm (IQR, 25, 29 mm) and Medtronic Evolut 29 mm (29, 34 mm), whereas the SAVR + Y-AAE group had a median implant size of 29 mm (27, 29 mm). Compared with the TAVR group, the SAVR + Y-AAE group had similar operative mortality (0% vs 2%; P > .99) and lower postoperative pacemaker implantation rate (1.4% vs 10.3%; P = .03). At 24 to 36 months postoperative, the SAVR + Y-AAE group had significantly larger effective orifice area (2.7 vs 1.9 cm2), lower aortic valve mean gradients (5 vs 9.5 mm Hg), greater dimensionless index (0.67 vs 0.54), lower rates of aortic insufficiency (3.0% vs 26%), and less moderate/severe prosthesis-patient mismatch (0% vs 20.1%). The left ventricular mass index regression was greater in SAVR + Y-AAE patients (42% vs 22%; P = .05). The SAVR + Y-AAE 3-year survival was 96% versus 79% for TAVR in the propensity-score matched cohort (P = .12). The hazard ratio of SAVR + Y-AAE for early mortality was 0.15 (95% CI, 0.02-1.13; P = .066).
Conclusions:
Low- and intermediate-risk patients with aortic valve stenosis should be considered for SAVR + Y-AAE for excellent hemodynamics and early outcomes.
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