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Which Surgical Approach is better for Minimally Invasive Aortic Valve Replacement ? : A Comparison of Outcomes beween Right Anterior Minithoracotomy and Ministernotomy.
KAZUHIRO HISAMOTO, Marc P. Sakwa, Francis L. Shannon.
William Beaumont Hospital, Royal Oak, MI, USA.

OBJECTIVE: The purpose of this study was to compare the safety, feasibility and benefits between the right anterior minithoracotomy (RAT) approach and the ministernotomy (MST) approach in patients with minimally invasive aortic replacement (mini-AVR).
METHODS: We retrospectively reviewed 206 isolated mini-AVR cases from January 2008 to December 2011 in William Beaumont Hospital, Royal Oak.
RESULTS: Of the 206 patients, 117 patients underwent isolated mini-AVR via the RAT, 89 patients had the MST. The baseline characteristics were similar in both groups. There were no significant differences in the 30-day mortality (1.7% vs 2.2%, p=0.78) and the incidence of permanent stroke (0% vs 1.1%, p=0.25) between the RAT group and the MST group respectively. Cardiopulmonary bypass (CPB) time and an aortic cross clamp (ACC) time in patients with the RAT approach both were significantly longer than that of the MST group ( 115±23 min vs 94±17 min p<0.001, 85±13 min vs 72±14 min p<0.001). Intraoperative blood products were less frequently used in the RAT group when compared to the MST group (21% vs 44%, p=0.003). The length of hospital stay in patients with the RAT approach was significantly shorter than that in patients with the MST approach (7.8 days vs 9.4 days, p=0.045).
CONCLUSIONS: Mini-AVR via both approaches can be safe and feasible with excellent outcomes. Despite longer CPB and ACC time, the RAT approach for mini AVR has a less need for blood transfusion and results in shorter length of hospital stay when compared with the MST approach.

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