Partial Upper Sternotomy versus Right Thoracotomy with Central Cannulation for Surgical Aortic Valve Replacement

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Thoracic Surgery

Background:

• Surgical aortic valve replacement (SAVR) is a standard procedure for aortic valve disease.
• Minimally invasive approaches aim to reduce surgical trauma and improve patient outcomes.
• Partial upper sternotomy (PUS) and right anterolateral thoracotomy (RALT) are two such approaches for SAVR.

Purpose of the Study:

• To compare intraoperative perfusion, transfusion needs, and early postoperative outcomes of SAVR using PUS versus RALT with central aortic cannulation.
• To evaluate the safety and feasibility of RALT as an alternative to PUS for SAVR.

Main Methods:

• Retrospective analysis of 380 patients undergoing isolated SAVR via PUS or RALT.
• Propensity score matching created 107 matched pairs for comparison.
• Central aortic and peripheral venous cannulation were used in all patients.

Main Results:

• Right anterolateral thoracotomy (RALT) had longer cardiopulmonary bypass, aortic cross-clamp, and operative times but shorter reperfusion times.
• Transfusion requirements and intubation times were comparable between PUS and RALT groups.
• RALT was associated with shorter intensive care unit (ICU) and hospital stays, and lower vasopressor use, with no significant difference in complication rates or permanent pacemaker implantation.

Conclusions:

• Both PUS and RALT approaches for SAVR demonstrate low in-hospital mortality and similar complication rates.
• RALT, despite longer operative times, offers benefits of shorter recovery periods and reduced vasopressor support.
• RALT with central aortic cannulation is a safe and viable alternative to PUS for minimally invasive SAVR.