Outcome of mini aortic valve replacement via right parasternal mini-thoracotomy in patients with challenging anatomy

Objective: To describe the diagnostic features, surgical techniques, and outcomes of minimally invasive aortic valve replacement via right parasternal thoracotomy in patients with unfavorable anatomy. Methods: This is a retrospective descriptive study including 34 patients indicated for aortic valve replacement, with non-rightward-deviated ascending aorta on CT scan, who underwent minimally invasive aortic valve replacement via a right parasternal second intercostal mini-thoracotomy at Hanoi Heart Hospital from September 2023 to September 2024. Results: This retrospective descriptive study included 34 patients with a mean age of 63.3 years (range: 38–82 years). The mean aortic cross-clamp time, cardiopulmonary bypass time, and total operative time were 86 ± 27 minutes (range: 53–130 minutes), 130 ± 25 minutes (range: 80–170 minutes), and 215 ± 30 minutes (range: 155–250 minutes), respectively.The mean duration of postoperative mechanical ventilation was 18 ± 23.3 hours (range: 5–95 hours). The average length of stay in the intensive care unit (ICU) was 45 ± 42.5 hours (range: 30–170 hours), and the mean hospital length of stay was 10 ± 5 days (range: 5–15 days).There were no in-hospital mortalities and no conversions to full sternotomy. Postoperative complications included one case of re-exploration for chest wall bleeding (2.9%), one cerebrovascular accident (2.9%), two cases of pneumonia (5.8%), four cases of acute kidney injury (11.8%)—none of which required renal replacement therapy—one case of new-onset atrial fibrillation (2.9%), and one case of surgical site infection (2.9%). No other complications were recorded. Conclusion: Minimally invasive aortic valve replacement via right parasternal second intercostal mini-thoracotomy in patients with unfavorable anatomy at Hanoi Heart Hospital is a safe, feasible, and effective option. This approach contributes to reducing mortality and cardiovascular complications, while offering several advantages over the conventional method.