Clinical Outcomes of Isolated Right Anterior Mini-Thoracotomy Aortic Valve Replacement: A North American and European Multicenter Study

A. Fatehi Hassanabad¹, M. Fatehi Hassanabad², M. King¹, A. Manerikar³, A. Huskin³, J. Kruse⁴, M. Israr-Ul-Haq², A. Bergeron⁵, J. Fercho⁶, A. Maitland¹, D. Holloway¹, H. Smith¹, W. Karolak⁶, C. Malaisrie⁷, D. Bouchard⁸, C. Adams¹, W. Kent^1
1University of Calgary, Calgary, Alberta ²University of Alberta, Edmonton, Alberta ³Northwestern University, Chicago, Illinois ⁴Northwestern Medicine, Chicago, Illinois ⁵Universite de Montreal, Montreal, Quebec ⁶Medical University of Gdansk, Gdansk, Pomorskie ⁷Northwestern University Feinberg School of Medicine, Chicago, Illinois ⁸Universite de Montreal, Montreal, Alberta

Purpose: Right anterior mini thoracotomy (RAMT) can be used for aortic valve replacement. Several single-center studies have confirmed the feasibility of this operation. While these studies have found RAMT AVR to be associated with safe outcomes, there is a paucity of large, multi-center, all-comer and real-world data for this surgical strategy.

Methods: This retrospective study investigated the clinical outcomes of patients who underwent isolated, first time RAMT AVR at centers in Canada, the United States, and Europe. Primary outcomes were death and disabling stroke within 30 days of surgery. Secondary outcomes included rate of conversion to sternotomy, type of valve used, operative times, residual paravalvular leak (PVL), rate of permanent pacemaker (PPM) implantation, incidence of new onset post-operative atrial fibrillation (POAF), rate of post-operative blood transfusion, and length of ICU and hospital stay.

Results: Five-hundred and ninety patients underwent isolated RAMT AVR between January 2014 and July 2023. RAMT AVR was the first cardiac surgical intervention for all patients. Three-hundred and forty-nine were male and the average age at the time of surgery was 68.53±10.93 years. Two patients died within 30 days of surgery, while 10 experienced a debilitating stroke post-operatively. Conversion to sternotomy was required for 11 patients; Perceval was the most commonly used valve (288 patients); mean cardiopulmonary bypass and cross-clamp times were 81.42±30.25 and 60.17±24.08 minutes, respectively; 5 patients had PVL that was mild but none had moderate or severe PVL; a PPM was required for 34 patients; incidence of new onset POAF was 26%; the rate of packed red blood cell transfusion was 4.75% (for 28 patients); and mean length of ICU and hospital stay was 1.74 and 6.88 days, respectively (Table 1).

Conclusion: This is the largest multi-center study reporting the clinical outcomes of isolated RAMT AVR. Our findings suggest that this is a safe and effective operation for appropriately selected patients, and it may have advantages with a lower incidence of post-op atrial fibrillation and less blood loss. Future studies should be conducted to compare the long-term outcomes of RAMT AVR to conventional sternotomy and transcatheter approaches.

Identify the source of the funding for this research project: No funding to report.