Right anterior mini thoracotomy approach for isolated aortic valve replacement: Early outcomes at a Canadian center

Abstract

Objective: The goal of this manuscript was to report the clinical outcomes of the initial series of 100 consecutive Right Anterior Mini Thoracotomy (RAMT) aortic valve replacement (AVR) implantations at a Canadian Center.Methods: This retrospective study reported the clinical outcomes of the first 100 patients who underwent the RAMT approach for isolated surgical AVR in Calgary, Canada, between 2016 and 2020. Primary outcomes were death within 30 days of surgery and disabling stroke. Secondary outcomes included surgical times, the need for permanent pacemaker (PPM), incidence of postoperative blood transfusion in the intensive care unit (ICU), postsurgical atrial fibrillation (AF), length of ICU/hospital stay, postsurgical AF, residual paravalvular leak (PVL), postoperative transvalvular gradient, need for postsurgical intravenous opioids, duration of invasive ventilation in the ICU, and chest tube output in the first 12 h postsurgery.Results: In this study, 54 patients were male, and the average age of the cohort was 72 years. Mortality within 30 days of surgery was 1% with no disabling postoperative strokes. Mean cardiopulmonary bypass and cross clamp was 84 and 55 min, respectively. PPM rate was 3%, incidence of blood transfusion in the ICU was 4%, and the rate of postoperative AF was 23%. Median length of ICU and hospital stay was 1 and 5 days, respectively. Rate of mild or greater residual PVL was 3%, while the average residual transvalvular mean gradient was 8.5 mmHg. Conclusion:The sternum-sparing RAMT approach can be safely integrated into surgical practice as a minimally invasive alternative for isolated AVR, and can reduce postoperative bleeding and narcotic requirements.

Totally Endoscopic Replacement of the Ascending Aorta and the Aortic Root including the Aortic Valve via Right Mini-Thoracotomy: A Multicenter Study

“…Minimally invasive cardiac surgery has been widely adopted worldwide and is showing a growing trend. Complex cardiac surgical procedures using the RAMT approach are increasingly performed in many cardiac surgery centers worldwide [7][8][9][10][11][12]. The aim of minimally invasive surgery is to avoid a complete sternotomy and its associated complications by reducing the morbidity and mortality [7,28,29].…”

“…Since the late 1990s, minimally invasive surgery via right anterolateral mini-thoracotomy (RAMT) access has been increasing and gaining popularity in cardiac surgery in order to optimize surgical procedures and results. Actually, minimally invasive surgery via RAMT has become established in many centers worldwide in the field of valve surgery [1][2][3][4][5][6][7][8][9][10][11][12].…”

Totally Endoscopic Replacement of the Ascending Aorta and the Aortic Root including the Aortic Valve via Right Mini-Thoracotomy: A Multicenter Study

“…Minimally invasive cardiac surgery has been widely adopted worldwide and is showing a growing trend. Complex cardiac surgical procedures using the RAMT approach are increasingly performed in many cardiac surgery centers worldwide [7][8][9][10][11][12]. The aim of minimally invasive surgery is to avoid a complete sternotomy and their associated complications by reducing the morbidity and mortality [7,28,29].…”

“…Since the late 1990´s minimally invasive surgery via right-anterolateral mini-thoracotomy (RAMT) access has been increasing and gaining popularity in cardiac surgery in order to optimize surgical procedures and results. Actually, minimally invasive surgery via RAMT has become established in many centers worldwide in the field of valve surgery [1][2][3][4][5][6][7][8][9][10][11][12]. The standard surgical approach for the treatment of pathologies of the ascending aorta (AA) and the aortic root is the Disclaimer/Publisher's Note: The statements, opinions, and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s).…”

Supplement to right anterior mini‐thoracotomy approach for isolated aortic valve replacement

“…We have read with great interest about Fatehi et al's experience of right anterior mini thoracotomy approach for isolated aortic valve replacement (AVR). 1 We also congratulate the authors on the quality of their work, which provides a valuable experience about minimally invasive AVR. They demonstrated in a retrospective study that minimally invasive AVR provides favorable short-term clinical outcomes, reduces postoperative bleeding and the requirement for anesthesia, and concluded that minimally invasive AVR could be a reliable treatment.…”