Minimally invasive (limited right anterior thoracotomy) versus conventional approach (median sternotomy) for aortic valve surgery

Background Minimally invasive aortic valve replacement (MIAVR) has been shown to achieve similar mortality rates to conventional aortic valve replacement, with a smaller incision, lower ventilation time, pain scores, ICU stay, and hospital stay. More efforts should be put in supporting a variety of these strategies. Objective The aim was to compare the preoperative and postoperative outcomes of aortic valve replacement through minimal invasive approach (limited right anterior thoracotomy) and the conventional approach (median sternotomy). Patients and methods In a multicenter study, 50 consecutive adult patients with severe aortic valve disease scheduled for elective aortic valve replacement in Armed Forces Hospitals from December 2018 to June 2021 were prospectively randomized to undergo either operation through conventional median sternotomy and central cannulation for standard cardiopulmonary bypass (CBP) (MS group I, n=25) or minimally invasive surgery through right anterior small thoracotomy (RAMT group II, n=25). Preoperative clinical evaluation, intraoperative data (site and length of incision and type of cannulation), CBP, and aortic cross-clamp times were evaluated. Postoperative ICU support, including mechanical, chemical (Inotropes), and blood and fluid supports, was evaluated. ICU and hospital stays, ICU mortality, operative cost, and postoperative complications were evaluated. Results The incision length was significantly shorter in the RAMT group compared with the conventional group (5.5 vs. 14.5 cm, with P<0.0001). Patients in the RAMT group had longer CBP time (189.1 vs. 166.6 min, P=0.031) and cross-clamping time (141.9 vs. 118.0 min, P=0.003), with nearly equal operative times between the two procedures, and no cases in RAMT were converted to conventional sterornotomy. MIAVR by way of RAMT was associated with significantly lower output of chest drain, lower incidence of usage of blood components, shorter mechanical ventilation time, shorter ICU stay, and shorter hospital stays. RAMT was associated with significantly lower postoperative pain score, with excellent significant scores. However, conventional sternotomy was less costly than RAMT. Conclusion MIAVR by right anterior minithoracotomy is a safe and effective surgical method with lower rate of blood loss, as well as a shorter time on mechanical ventilation, time in the critical care unit, and length of hospital stay. More research is needed that includes patients with recorded data after a 1-year follow-up. In addition, in future research, a patient satisfaction survey should be done.