Mini-sternotomy vs right anterior thoracotomy for aortic valve replacement

Mohammad Yousuf Salmasi, Hamish Hamilton, Ishtiaq Rahman, Lueh Chien, Paul Rival, Umberto Benedetto, Christopher Young, Massimo Caputo, Gianni D Angelini, Hunaid A Vohra

Research output: Contribution to journalReview article (Academic Journal)peer-review

14 Citations (Scopus)


BACKGROUND: While minimally invasive techniques for aortic valve replacement (AVR) have been shown to be safe, limited data exist comparing the varying approaches. This study aimed to compare the outcomes between two minimally invasive approaches for AVR: mini-sternotomy (MS) and right anterior thoracotomy (RAT).

MATERIALS AND METHODS: A systematic search of MEDLINE, EMBASE, and OVID was conducted for the period 1990-2019. Nine observational studies (n = 2926 patients) met the inclusion criteria.

RESULTS: There was no difference in operative mortality between MS and RAT (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.41-1.85; P = .709). Meta-analyses favored MS over RAT in reoperation for bleeding (OR: 0.42, 95% CI: 0.28-0.63; P < .001), aortic cross-clamp time (standardized mean difference [SMD]: -0.12, 95% CI: -0.20 to 0.029; P = .009), and the rate of conversion to sternotomy (OR: 0.32, 95% CI: 0.11-0.93; P = .036). The rate of permanent pacemaker insertion approached borderline significance in favor of MS (OR: 0.54, 95% CI: 0.26-1.12; P = .097). In-hospital outcomes of stroke, atrial fibrillation, and surgical site infection were similar between the two groups. The length of hospital stay was shorter for RAT (SMD: 0.12, 95% CI: 0.027-0.22; P = .012) and the length of postoperative ventilation was borderline significant in favor of RAT (SMD: 0.16, 95% CI: -0.027 to 0.34; P = .095).

CONCLUSIONS: This study highlights important differences in short-term outcomes between MS and RAT as approaches for AVR. This has important implications for patient selection, especially in the elderly, where such approaches are becoming more common-place.

Original languageEnglish
Pages (from-to)1570-1582
Number of pages13
JournalJournal of Cardiac Surgery
Issue number7
Publication statusPublished - Jul 2020

Bibliographical note

© 2020 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.

Structured keywords

  • Bristol Heart Institute


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