Sutureless Aortic Valve Replacement Through Lateral Mini-Thoracotomy-Feasibility and Effectiveness

Background: Minimally invasive sutureless aortic valve replacement with the Perceval bioprosthetic heart valve (MISUAVR) is commonly performed through a right anterior thoracotomy (AT). However, a lateral thoracotomy (LT) may be superior as it does not require rib and right internal thoracic artery (RITA) cutting.Methods and Results: In total, 38 MISUAVRs performed from May 2019 to approximately August 2021 were retrospectively reviewed; 21 through LT (Group L), and 17 through AT (Group A). In Group L, the skin incision was made on the right anterior axillary line and third intercostal space, and in group A, on the right anterior chest and second or third intercostal space. All other surgical techniques were the same. Age, body surface area, EuroSCORE II, and ejection fraction were similar between the patients. Cardio-pulmonary bypass (L: 82 +/- 19 vs. A: 93 +/- 28 min, P=0.19) and cross-clamp times (L: 57 +/- 13, vs. A: 64 +/- 23 min, P=0.19) were similar. Rib and/or RITA cutting were required in 94.6% of patients in group A and in none of group L (P<0.001). Surgical visualization score was better in group L (L: 1.19 +/- 0.40 vs. A: 1.94 +/- 0.69, P<0.01). Total amount of intraoperative bleeding was lower in group L (L: 623 +/- 141 vs. A: 838 +/- 316 mL, P<0.01). Duration of hospital stay was similar (P=0.30).Conclusions: MISUAVR through LT has multiple advantages over AT.