Ministernotomy compared to right anterior minithoracotomy for aortic valve surgery

Objectives Ministernotomy (MS) and right anterior minithoracotomy (MT) are the two main techniques applied for minimally invasive aortic valve replacement (AVR). The goal of this study is to compare early and long-term outcomes of both techniques. Methods The data of 2419 patients undergoing isolated minimally invasive AVR between 1999 and 2019 were prospectively collected. Retrospectively, patients were divided into the MS group (n=1,352) and the MT group (n= 1,067). Results Following propensity score matching, 986 patients remained in each group. Operation time and rate of conversion to full sternotomy were significantly higher in the MT versus MS group (184.6±45.2 vs 241.3±68.6, RR= 2.54 p=0.005 and 0.09 vs 0.23, RR= 1.45 p= 0.013, respectively). The 30-days mortality, excluding cardiac death, was lower in the MS vs MT group (0.012. vs 0.028, RR=1.41, p=0.011, respectively); the intensive care unit (ICU) length of stay (12.4 vs 16.5, RR= 1.62, p=0.037, respectively) and hospital length of stay (5.4 vs 8.7, RR= 1.74 p=0.028, respectively) were significantly longer in the MT group. The MT surgical approach resulted in being the strongest independent predictor for early mortality (OR 4.24 [1.67-7.35], p=0.002). The actuarial survival by Kaplan – Meier analysis at 1, 3, 5, 10, and 20-years was significantly better in the MS versus MT (p=0.0001). Actuarial freedom from re-operation at 5-years was 97.3±4.4% in MS versus 95.8±5.2% in MT, p=0.087. Conclusions Minimally invasive AVR using MS is associated with reduced operative time, ICU and hospital length of stay, lower postoperative morbidities and incisional pain and improves early and log-term mortality.