title: Right anterior minithoracotomy for aortic valve replacement: 10-year experience of a single center.
abstract: OBJECTIVE
  Minimally invasive aortic valve replacement (AVR) has been associated with several better outcomes over the standard full sternotomy approach. We revised our 10-year experience with right anterior minithoracotomy (RAMT) for AVR.
  
  
  METHODS
  Between 2004 and 2014, a total of 593 patients (310 men; median age: 73.8 years) underwent AVR via RAMT. Preoperatively, a mixed valve lesion was diagnosed in 55 (9.3%) patients; and pure aortic regurgitation in 86 (14.5%). Mean logistic EuroSCORE I (European system for cardiac operative risk evaluation) was 7.4 (median: 5.76).
  
  
  RESULTS
  In 302 (50.9%) patients, a sutureless or rapidly implantable biological prosthesis was used; in 23 (3.9%), a mechanical prosthesis; and in the remainder, a conventional biological prosthesis. A total of 113 (19.1%) patients had a small aortic annulus (≤21 mm). Operative times averaged 80 (median: 74) minutes of crossclamping time, and 117 (107) minutes of perfusion time; these were significantly shorter with a sutureless prostheses, compared with a sutured prostheses: perfusion 99 versus 134 minutes, P < .0005; aortic crossclamping time: 64 versus 97 minutes, P < .0005. The mean (median) assisted ventilation time was 9.8 (6) hours; intensive care unit stay was 1.5 (1) days; hospital length of stay was 6.6 (6) days. Overall in-hospital mortality was 9 deaths (1.5%). At 31.5 months mean follow-up time (1531 cumulative patient-years), 94.8% survival was observed.
  
  
  CONCLUSIONS
  Minimally invasive AVR is a safe procedure, with low perioperative morbidity, and low rates of reoperation and death at late follow-up. Excellent outcomes can be achieved with minimally invasive AVR via right anterior minithoracotomy. Sutureless prostheses facilitate minimally invasive AVR and are associated with reduced operative times.
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy. Electronic address: drgilmanov@hotmail.it.
authors.forename: Daniyar
authors.initials: D
authors.lastname: Gilmanov
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy.
authors.forename: Pier Andrea
authors.initials: PA
authors.lastname: Farneti
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy.
authors.forename: Enkel
authors.initials: E
authors.lastname: Kallushi
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaramonti
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.affiliation: Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solinas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic valve replacement; minimally invasive aortic valve replacement; right anterior minithoracotomy; sutureless aortic valve prosthesis