Minimally Invasive Aortic Valve Replacement Through Right Mini-Thoracotomy in Patients with Heart Failure: A Multicentric Retrospective Study

Background: In the era of minimally invasive cardiac surgery, left ventricular function in patients scheduled for aortic valve replacement (AVR) is inadequately considered in the decision-making process. The timing and magnitude of recovery in patients with low left ventricle ejection fraction (LVEF) in minimally invasive AVR through right anterior mini-thoracotomy (RAMT) is not well studied. We aim to investigate clinical outcomes following AVR via RAMT in the subset of patients with reduced LVEF (≤40%) and to evaluate significance of left ventricular dysfunction on the perioperative outcome.

Methods: Between March 2017 and February 2024, 1,117 patients underwent minimally invasive aortic valve replacement surgery via RAMT at three cardiac referral centers in Germany. Among these, 73 patients suffered from heart failure with a LVEF of less than 40%. Clinical data of the patients were retrospectively analyzed. Primary endpoints was 30-day mortality. Secondary endpoints were in-hospital mortality, operation-related morbidity such as bleeding, wound healing disorders, cerebrovascular events, pacemaker implantation as well as operative times and duration of hospitalization.

Results: Median age was 70 (60–76) years old. 21.9% of patients were female gender. Operative success occurred in 100% of patients. Median aortic cross-clamping time was 55 (44–67) min. Median CPB time was 90 (73–110) min. Postoperative intrathoracic bleeding occurred in 3 (4.1%) patients and there was 1 (1.4%) conversion to full sternotomy. Median ICU stay and hospital stay were 1 (1–2) days and 10 (7–14) days, respectively. Mean ventilation duration was 16.11 ± 22.4 hours. Postoperative stroke and pacemaker implantation were noted in 2 (2.7%) and 3 (4.1%) patients, respectively. 30-day mortality and in-hospital mortality were 1.4% (1 patients) and 2.7% (2 patients), respectively.

Conclusion: Minimally invasive aortic valve replacement via RAMT is a safe and effective approach with low mortality and morbidity even in patients with heart failure. It is associated with a very short stay in the intensive care unit as well as a short hospital stay overall.

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Artikel online veröffentlicht:
11. Februar 2025