Minimally Invasive Aortic Valve Replacement Through Right Mini-Thoracotomy versus Full Sternotomy in Patients with a Body Mass Index over 30

Background: Propensity score analysis of short-term outcomes after isolated aortic valve replacement (AVR) through right anterior mini-thoracotomy (RAMT) and full sternotomy (FS) could provide information on the most beneficial technique for obese patients, who are known for their high risk of complications after cardiac surgery.

Methods: Between March 2017 and February 2024, 451 patients with BMI of 30 kg/m² and over received surgical AVR surgery, excluding the partial upper sternotomy surgical access, at three cardiac referral centers in Germany. Among these, 336 right anterior mini-thoracotomies and 115 full sternotomies were performed. A propensity score analysis was performed in 97 matched pairs. Clinical data of the patients were retrospectively analyzed. Primary endpoint was 30-day mortality. Secondary endpoints were in-hospital mortality, operation-related morbidity such as bleeding, wound healing disorders, re-exploration as well as operative times and duration of hospitalization.

Results: Mean age was 66.3 ± 8.9 years old and median BMI 32.6 (31–35.4) kg/m² across both groups. In the matched group, mean aortic cross-clamping time was 60.6 ± 23.4 minutes for RAMT patients versus 60.1 ± 21.7 minutes in the FS group (p = 0.873). Cardiopulmonary bypass time was also similar in both groups (99.1 ± 37.3 vs. 92.1 ± 34 minutes, p = 0.173). Median postoperative ventilation duration was significantly shorter in the RAMT group (8 [5–12] vs. 10 [8–18], p = 0.003). 30-day mortality occurred in 4.1% in the RAMT group versus 3.1% in the sternotomy group (p = 0.453). 4.3% of the RAMT patients had intrathoracic bleed versus 3.1% of sternotomy patients (p = 0.688). Median intensive care and hospital stay duration were similar in both groups (1 [1–2] vs. 1 [1–2] days, p = 0.793). Two (2.1%) patients of the RAMT group had thorax wound revision versus 10 (10.3%) patients of sternotomy group (p = 0.012).

Conclusion: Minimally invasive AVR via RAMT has been shown to be as safe and effective as sternotomy for obese patients. Compared with FS, RAMT technique is associated with a lower rate of wound healing disorders and a shorter postoperative ventilation time. According to the results of this study, obesity should not be an exclusion criterion for minimally invasive surgery for AVR via RAMT.

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Artikel online veröffentlicht:
11. Februar 2025