Minimally Invasive Aortic Valve Replacement via Right Mini-thoracotomy versus Conventional Full Median Sternotomy: Tertiary Center Experience

Introduction: Minimally invasive approach to Aortic Valve Replacement (AVR) is increasingly accepted as a valid alternative to full sternotomy approach, as to reduce operative trauma with the final aim to improve post-operative outcomes. The aim of this work is to evaluate the feasibility of minimally invasive aortic valve surgery through a right mini-thoracotomy, and hence to minimize the surgical access to achieve better cosmetic results, less postoperative discomfort and faster recovery while maintaining the same level of safety and favorable results as with conventional surgery. Methods: In this study a 150 patients with Aortic Valve Disease (AVD) requiring aortic valve surgery were none randomly selected. The study was performed at Benha University Hospital & the Armed Forces Hospitals. Seventy five patients underwent aortic valve surgery by traditional median sternotomy with central cannulation (group B), the other seventy five patients by right mini-thoracotomy on 2nd or 3rd right intercostal space with peripheral femoral cannulation (group A). Endpoints were overall postoperative complications, major adverse cardiac related complications, use of blood products and need for transfusions, bypass time and cross clamp time, ventilation time and length of hospital-stay. Results: Minimally invasive AVR was associated with a significant reduction in need for blood and blood products transfusions, as well as postoperative cardiac and non-cardiac complications. Post-operative pain was significantly reduced in the mini-invasive group, a trend to lower mean ventilation times, ICU stay and hospital-stay in the mini-invasive group was also detected. Conclusion: Minimally invasive aortic valve surgery has evolved into a well tolerated, efficient surgical treatment option in experienced centers, providing greater patient satisfaction and lower complication rates. Potential advantages of Minimally Invasive Aortic Valve Replacement (MIAVR) arise from the concept that patient morbidity and potential mortality could be reduced without compromising the excellent results of the conventional procedure and include improved cosmetic results, safer access in the case of re-operation, less post-operative bleeding, less blood transfusions, lower intensive care unit and in-hospital stays, as well as the absence of sternal wound infection