Midterm Outcomes of Right Anterior Mini Thoracotomy Aortic Valve Replacement

Background

Contemporary surgical approaches for aortic valve replacement (AVR) include full median sternotomy, hemi-sternotomy, and a right anterior mini thoracotomy (RAMT) approach. We report the midterm outcomes of RAMT for isolated AVR.

Methods

A retrospective study was conducted, reporting the midterm outcomes of patients who underwent isolated RAMT AVR. The primary outcomes were death and disabling stroke within 30-days of surgery. The secondary outcomes were survival at latest follow-up assessment, hospital readmission for aortic valve disease, prosthetic valve function, and incidence of structural valve deterioration requiring reintervention on the aortic valve.

Results

Seventy patients underwent isolated RAMT AVR between February 2016 and February 2018. One patient died from a cardiac cause within 30 days of surgery, whereas none experienced disabling postoperative strokes. The mean follow-up period for the cohort was 74.46 ± 7.54 months. At 95 months, a total of 49 patients were alive. During the follow-up period, 2 patients underwent median sternotomy, 1 for mitral valve replacement and tricuspid repair, and 1 for coronary artery bypass grafting. At last follow-up assessment, the average mean transvalvular gradient was 12.11 ± 9.15 mm Hg. One patient developed prosthetic valve infective endocarditis, and 1 patient was found to have prosthetic valve thrombosis. Prosthetic valve function was normal in 66 patients. At 95 months, freedom from aortic valve reintervention was 98.6%, as 1 patient required redo aortic root surgery.

Conclusions

RAMT AVR can be done safely in the appropriate patient population. Midterm outcomes at our centre are promising, and they suggest that this approach is a good option for managing aortic stenosis.