Right anterolateral mini-thoracotomy and full sternotomy approaches for Wheat procedure: a propensity-matched comparison

BACKGROUND: As the prevalence and technological advancements of minimally invasive heart surgery continue to increase, aortic valve replacement(AVR) via right anterolateral mini-thoracotomy (RAMT) has matured, however, problems associated with Wheat's procedure (replacement of the ascending aorta(AAR) concomitant AVR) via RAMT approach have not been reported. The objective of this study was to compare the surgical quality, postoperative outcomes, and patient safety in patients undergoing Wheat's procedure via Full sternotomy (FS) versus RAMT. METHODS: A retrospective analysis was conducted on the clinical data of 163 patients who underwent Wheat procedure between January 2022 and December 2024. Out of the 163 patients, 59 underwent the Wheat procedure via a right anterior minimally invasive incision. After 1:1 propensity score matching, by comparing various intraoperative and postoperative indicators, the outcomes of patients undergoing RAMT and FS were compared. RESULTS: Propensity scores identified 43 patients per group with similar baseline profiles. The results from the propensity-matched cohort are as follows. Although patients in RAMT group had longer cardiopulmonary bypass (RAMT 167 ± 57 vs FS 141 ± 40 min; P = 0.04) and cross-clamp (RAMT 128 ± 39 vs FS 110 ± 29 min; P = 0.04) time, they experienced reduced intraoperative blood loss (RAMT 317 ± 147 vs FS 456 ± 229 ml; P = 0.005). No patients in the RAMT group required intraoperative conversion to Full sternotomy. There was no statistically difference in the in-hospital mortality between the two groups (0% and 0% in RAMT and FS, respectively). RAMT was correlated with a reduced incidence of postoperative atrial fibrillation (RAMT 3 [7.0%] vs FS 13 [23.3%]; P = 0.04). Receiving RAMT can lead to a reduction in postoperative NRS pain scores and an earlier discharge for patients. RAMT not only enables shorter incisions (RAMT 6.0 cm vs FS 15.2 cm; P < 0.001) but also has no impact on the size or type of the artificial valve or vessel implanted, thereby ensuring that the surgical effection is non-inferior to the FS group. CONCLUSIONS: In the Wheat procedure, the perioperative outcomes of RAMT closely resemble those of full sternotomy, and may be transferred in the field of cardiac surgery.