title: A comparison of minimally invasive and standard aortic valve replacement.
abstract: The study objective was to compare aortic valve replacement through a right anterior minithoracotomy with aortic valve replacement through a median sternotomy.
  
  
  
  With propensity score matching, we selected 211 patients after aortic valve replacement through a right anterior minithoracotomy and 211 patients after aortic valve replacement who underwent operation between January 2010 and December 2013. Perioperative outcomes were analyzed, and multivariable logistic regression analysis of risk factors of postoperative morbidity was performed.
  
  
  
  For propensity score-matched patients, hospital mortality was 1.0% in the aortic valve replacement through a right anterior minithoracotomy group and 1.4% in the aortic valve replacement group (P = 1.000). Stroke occurred in 0.5% versus 1.4% (P = .615), myocardial infarction occurred in 1.4% versus 1.9% (P = 1.000), and new onset of atrial fibrillation occurred in 12.8% versus 24.2% (P = .003) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Postoperative drainage was 353.5 ± 248.6 mL versus 544.3 ± 324.5 mL (P < .001) and blood transfusion was required for 48.8% versus 67.3% (P < .001) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Mediastinitis occurred in 2.8% of patients after aortic valve replacement and in 0.0% of patients after aortic valve replacement through a right anterior minithoracotomy surgery (P = .040). Intensive care unit stay (1.3 ± 1.2 days vs 2.6 ± 2.6 days) and hospital stay (5.7 ± 1.6 days vs 8.7 ± 4.4 days) were statistically significantly shorter in the aortic valve replacement through a right anterior minithoracotomy group. Aortic valve replacement through a right anterior minithoracotomy surgery resulted in reduced postoperative morbidity (odds ratio, 0.4; P < .001) and postoperative bleeding and blood transfusion requirements (odds ratio, 0.4; P < .001).
  
  
  
  Aortic valve replacement through a right anterior minithoracotomy surgery resulted in a reduced infection rate, diminished postoperative bleeding and blood transfusion requirements, reduced occurrence of new onset of atrial fibrillation, and shorter intensive care unit and hospital stays.
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland. Electronic address: jstolinski@gmail.com.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Stoliński
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Plicner
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Grudzień
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marcin
authors.initials: M
authors.lastname: Wąsowicz
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Musiał
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Andres
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Bogusław
authors.initials: B
authors.lastname: Kapelak
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D057216:Propensity Score; D012307:Risk Factors; D056346:Sternotomy; D013908:Thoracotomy; D016896:Treatment Outcome
keywords: aortic valve replacement; minimally invasive aortic valve surgery; right anterior minithoracotomy