Minimally Invasive Aortic Valve Replacement via Right Mini-thoracotomy in Patients under 50 Years of Age

Background: Minimally invasive aortic valve surgery via right anterior mini-thoracotomy (RAMT) access has been gaining popularity in cardiac surgery. This access can be a good option in relatively younger patients with longer life expectancy due to the lower morbidity profile in addition to the esthetic advantages. The current study investigates the clinical outcomes of patients under 50 years of age who received minimally invasive endoscopic assisted replacement of the aortic valve via RAMT.

Methods: Between April 2017 to September 2023, 51 patients under 50 years of age underwent endoscopic minimally invasive aortic valve replacement surgery at two cardiac referral centers in Germany. Clinical data of the patients were retrospectively analyzed. Primary endpoints were early and in-hospital mortality.

Results: Median age was 46 [39–49] years old with 86% of male gender. 2 (3.9%) patients received double valve surgery, one of which received a concomitant mitral valve replacement and one patient a concomitant tricuspid valve repair. 45 (88.2%) patients received a biological prosthetic aortic valve. Operative success occurred in 100% of patients with no postoperative paravalvular leak. Median aortic cross-clamping time was 59.5 [42–89] min. There was no postoperative intrathoracic bleeding and no patient had to undergo a rethoracotomy. 13% of the patients received transfusion of red cell blood units (RBC). Conversion to sternotomy was zero. Median ICU stay was 1 [1–2] days and median hospital stay was 6 [4–10] days. 2 (3.9%) patients required a prolonged intubation for respiratory insufficiency. 30-day mortality and in-hospital any cause mortality was zero. There was also no wound revisions and wound dehiscence. At a median follow-up time of 43.8 ± 16 months, all patients were alive without any cardiac related reoperations, structural valve degenerations or new cardiac or cerebrovascular events.

Conclusion: Minimally invasive replacement of the aortic valve via endoscopic RAMT without removing the ribs or transection of the right mammarial artery can be safely and effectively performed in patients younger than 50 years with rapid postoperative recovery and satisfying midterm outcomes. In selected nonelderly patients, this technique should be considered as an option for surgeons performing aortic valve surgery.

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Artikel online veröffentlicht:
13. Februar 2024