Aortic valve replacement through right minithoracotomy: is it really biologically minimally invasive?

Background: Minimally invasive aortic valve replacement through a right mini-thoracotomy is a procedure developed in the past few years. Currently, the main limits of this technique are longer cardiopulmonary bypass time compared with the standard approach and the need for peripheral cannulation.

Methods: From January 2010 to March 2014, 206 patients underwent an aortic valve replacement using a minimally invasive technique through a right mini-thoracotomy. Mean age was 71.4 ± 12.0 years, and 129 (62.6%) were male. In the first series of 42 patients, the vacuum-assisted venous drainage was obtained percutaneously through the groin. A totally central arterial and venous cannulation was adopted in the subsequent 164 patients. Two hundred patients (97.1%) received a bioprosthesis implanted with three 2-0 Prolene running sutures; a mechanical valve was implanted in six patients. One patient required reoperation.

Results: Aortic valve replacement was performed through a 4-6-cm skin incision at the third intercostal space. Overall cardiopulmonary bypass was 64.8 ± 17.2 min, and aortic cross clamping was 51.8 ± 14.9 min. In-hospital mortality was 1.5% (3/206).

Conclusions: Our initial series confirms that aortic valve replacement performed through a right mini-thoracotomy is a safe procedure. When using running sutures, it is possible to obtain cardiopulmonary bypass and cross-clamping times comparable to those for the standard approach. A central cannulation can be performed easily to avoid groin incisions. In conclusion, we believe that this kind of surgery could really be a biologically minimally invasive approach, rather than just an aesthetic choice.