Anterolateral approach for minimally invasive aortic valve replacement

Objective

Right anterior thoracotomy is the most common approach of minimally invasive aortic valve replacement (MIAVR) via intercostal mini-thoracotomy. However, there are some disadvantages including sacrificing the right internal thoracic artery (RITA). The aim of the present study was to investigate the efficacy of anterolateral thoracotomy (ALT), which is similar to lateral thoracotomy used for minimally invasive mitral valve surgery, for MIAVR.

Methods

From October 2012 to June 2013, 21 patients underwent MIAVR through ALT. Perioperative outcome of these patients was compared with those of 59 patients who underwent MIAVR via standard anterior thoracotomy (SAT) from May 2007 to September 2012.

Results

Mean age, body surface area, annular size, the ratio of aortic stenosis, and Japan score (30 days mortality), in ALT group were significantly more severe than those in SAT group. There was no significant difference in operative time; however, cardiopulmonary bypass and cross-clamping times in ALT group were significantly longer than those in SAT group. Significant differences were not found in mortality, morbidity, intubation time, blood transfusion rate, intensive care unit stay, hospital stay, and echocardiographic data such as effective orifice area index between both groups.

Conclusions

Anterolateral approach has several advantages including no need to sacrifice the RITA and cosmetic benefit in female patients, offering similar results as SAT even with more severe patient characteristics.