Right anterior mini-thoracotomy for isolated aortic valve replacement: An international and multicenter study

Background: Right anterior mini thoracotomy (RAMT) is a sternum-sparing approach for aortic valve replacement (AVR).Single-center studies have found RAMT AVR to be safe; however, there is a paucity of large, multicenter, allcomer, and real-world data for this surgical strategy.Methods: This retrospective study investigated the outcomes of isolated RAMT AVR at 6 centers in the United States, Canada, and Europe.Primary outcomes were death and disabling stroke within 30 days of surgery.Secondary outcomes included rate of conversion to sternotomy, prosthetic used, operative times, residual paravalvular leak, rate of permanent pacemaker (PPM) implantation, incidence of new onset postoperative atrial fibrillation (POAF), rate of blood transfusion, and intensive care unit and hospital length of stay.Results: Seven hundred and sixteen patients underwent isolated RAMT AVR between January 2012 and December 2024 across 6 centers.Four hundred and twenty-eight were male, and the mean age of the cohort was 68.1 10.7 years.Six patients (0.8%) died and 3 (0.4%) experienced a disabling stroke.Thirteen patients (1.8%) required emergent reoperation to control bleeding, while 45 (6.3%) received transfused blood products.One hundred and thirty patients (18.2%) experienced POAF.The incidence of permanent pacemaker implantation after a sutured valve replacement was 2.51% (n = 18 patients).The median intensive care unit and hospital length of stay was 1 day and 5 days, respectively. Conclusions:The findings of this study, the largest multicenter study on RAMT AVR reported to date, suggest that this is a safe operation associated with excellent outcomes.(JTCVS Open 2025;:101553)The surgical setup for RAMT AVR (left) and the postoperative incision (right). CENTRAL MESSAGERight anterior mini thoracotomy aortic valve replacement can be done safely, yielding excellent outcomes across different regions worldwide. PERSPECTIVELife-long management of aortic valve disease should be the cornerstone of treatment, and the timing and type of interventions should be carefully considered.In appropriately selected patients, a right anterior mini thoracotomy can facilitate excellent aortic valve replacement outcomes. See Commentary on page XXX.According to current North American and European guidelines, aortic valve replacement (AVR) is the gold standard treatment for severe, symptomatic aortic valve stenosis (AS). 1,2Conventional surgical aortic valve replacement (SAVR) through a median sternotomy has been the preferred approach for AVR in patients, with an acceptable