title: Right Anterior Mini-Thoracotomy: A 'New Gold Standard' for Aortic Valve Replacement?
abstract: BACKGROUND
  Details are provided of the authors' four-year experience with minimally invasive aortic valve replacement (AVR) through a right mini-thoracotomy, using totally central cannulation.
  
  
  METHODS
  Between November 2011 and October 2014, a total of 248 patients (143 males, 105 females; mean age 72.6 ± 11.5 years; range: 29-93 years) underwent isolated AVR through a right anterior mini-thoracotomy with total arterial and venous central cannulation.
  
  
  RESULTS
  AVR was performed through a 4- to 6-cm skin incision at the third intercostal space. The overall cardiopulmonary bypass time was 60.4 ± 16.7 min, and the aortic cross-clamp time 47.5 ± 14.1 min. A biological prosthesis was implanted in 242 patients (97.6%), using running sutures. The median intensive care unit and hospital stays were 40.5 h (IQR 24.6) and six days (IQR 6.0), respectively. In-hospital mortality was 1.2% (3/248); among 86 patients operated on during 2014 the hospital mortality was zero.
  
  
  CONCLUSIONS
  AVR performed via a right mini-thoracotomy with total central cannulation provided encouraging results. Adequate surgeon experience, in addition to technical expedience, are of utmost importance as demonstrated by the progressive and steady reduction in operating times. This approach may become highly competitive to a standard full sternotomy, and could become the 'new gold standard' for aortic valve surgery in the near future.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery Anesthesia, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA).
authors.forename: Elisa
authors.initials: E
authors.lastname: Mikus
authors.affiliation: Department of Cardiothoracic and Vascular Surgery Anesthesia, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA).
authors.forename: Simone
authors.initials: S
authors.lastname: Calvi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery Anesthesia, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA).
authors.forename: Marco
authors.initials: M
authors.lastname: Panzavolta
authors.affiliation: Department of Anesthesia, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA).
authors.forename: Josè
authors.initials: J
authors.lastname: Luis Zulueta
authors.affiliation: ES Health Science Foundation, Cotignola (RA), Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Dozza
authors.affiliation: Department of Cardiothoracic and Vascular Surgery Anesthesia, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA).
authors.forename: Andrea
authors.initials: A
authors.lastname: Cavallucci
authors.affiliation: Department of Cardiothoracic and Vascular Surgery Anesthesia, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA).
authors.forename: Mauro
authors.initials: M
authors.lastname: Del Giglio