Comparison of different surgical approaches for ascending aortic surgery with or without aortic valve involvement: Right anterior minithoracotomy versus conventional median sternotomy.

OBJECTIVES

Minimally invasive approach to cardiac surgery has been steadily developing and increasingly being performed since the early 1990s. We aimed to present our initial clinical experience and show the feasibility and safety of the right anterior minithoracotomy (RAT) approach for ascending aorta surgery with or without aortic valve involvement.

METHODS

This single-center study included 112 patients who underwent ascending aortic replacement with or without aortic valve intervention, between September 2018 and March 2024. RAT was performed for 48 (42.9%) patients (RAT Group) and conventional median sternotomy (CS) was performed in the remaining 64 (57.1%) (CS Group). The primary end points included operative variables, reoperation for bleeding, transfusion requirements, extubation time, length of intensive care unit stay, hospital stay, and postoperative complications.

RESULTS

The mean age was 67.63 ± 6.67 years, and 65.1% of patients were men. Total operation time was significantly lower in the CS group (237.84 ± 24.87 minutes vs 259.57 ± 27.41 minutes, respectively;  = .0001). The mean ventilation time (12.73 ± 2.96 hours vs 19.43 ± 4.21 hours) and the mean intensive care unit length of stay (1.71 ± 0.86 days vs 3.6 ± 1.71 days) were both shorter in the RAT group ( < .0001 for both). Wound infection was significantly lower in the RAT group ( = .036). The length of the hospital stay was significantly shorter in the RAT group compared with the sternotomy group (7.48 ± 0.91 days vs 10.6 ± 1.43 days;  < .0001).

CONCLUSIONS

RAT is a novel and promising approach for ascending aortic surgery with or without aortic valve involvement. This study confirms that this approach is feasible and safe.