title: Anterolateral approach for minimally invasive aortic valve replacement.
abstract: OBJECTIVE
  Right anterior thoracotomy is the most common approach of minimally invasive aortic valve replacement (MIAVR) via intercostal mini-thoracotomy. However, there are some disadvantages including sacrificing the right internal thoracic artery (RITA). The aim of the present study was to investigate the efficacy of anterolateral thoracotomy (ALT), which is similar to lateral thoracotomy used for minimally invasive mitral valve surgery, for MIAVR.
  
  
  METHODS
  From October 2012 to June 2013, 21 patients underwent MIAVR through ALT. Perioperative outcome of these patients was compared with those of 59 patients who underwent MIAVR via standard anterior thoracotomy (SAT) from May 2007 to September 2012.
  
  
  RESULTS
  Mean age, body surface area, annular size, the ratio of aortic stenosis, and Japan score (30 days mortality), in ALT group were significantly more severe than those in SAT group. There was no significant difference in operative time; however, cardiopulmonary bypass and cross-clamping times in ALT group were significantly longer than those in SAT group. Significant differences were not found in mortality, morbidity, intubation time, blood transfusion rate, intensive care unit stay, hospital stay, and echocardiographic data such as effective orifice area index between both groups.
  
  
  CONCLUSIONS
  Anterolateral approach has several advantages including no need to sacrifice the RITA and cosmetic benefit in female patients, offering similar results as SAT even with more severe patient characteristics.
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan, toshinoritotsugawa@gmail.com.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Totsugawa
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kuinose
authors.forename: Arudo
authors.initials: A
authors.lastname: Hiraoka
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshitaka
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D002315:Cardiopulmonary Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D061646:Operative Time; D011183:Postoperative Complications; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome