Rapid-Deployment Versus Sutured Aortic Valve Replacement Through Right Anterior Thoracotomy: A Single-Team Retrospective Comparison of Operative Efficiency in 192 Consecutive Patients

Minimally invasive aortic valve replacement through a right anterior thoracotomy is limited by prolonged operative times. We assessed whether a rapid-deployment prosthesis reduces those times and improves early outcomes when surgical access, team and era are held constant. Single-centre retrospective cohort study of 204 consecutive isolated aortic valve replacements performed through a right anterior thoracotomy by one surgical team between 2023 and 2025. Patients receiving a mechanical prosthesis (n = 5) or a 29 mm sutured valve (n = 7, a size not manufactured for the study device) were excluded, leaving 192 patients: 70 received the Edwards Intuity rapid-deployment valve and 122 a conventional sutured bioprosthesis. Prosthesis choice was at the surgeon’s discretion. Primary endpoints were aortic cross-clamp and cardiopulmonary bypass time. Groups were compared by multivariable regression adjusted for age, sex, EuroSCORE II, NYHA class, ejection fraction and implanted valve size, with robust standard errors for continuous outcomes and Firth-penalised logistic regression for binary outcomes. Aortic cross-clamp time was shorter with the Intuity (median 61.0 [54.0–75.0] versus 91.0 [76.0–108.5] min; adjusted difference −26.9 min, 95% CI −33.7 to −20.1; p < 0.001), as was cardiopulmonary bypass time (103.5 [84.2–115.0] versus 131.0 [115.0–153.0] min; adjusted difference −29.4 min, −38.7 to −20.2; p < 0.001). Mean and peak transvalvular gradients were lower (adjusted differences −5.52 mmHg, −6.80 to −4.25, and −11.50 mmHg, −13.90 to −9.10; both p < 0.001) and hospital stay was shorter by 1.4 days (−2.4 to −0.4; p = 0.009). In-hospital mortality was 1/70 versus 1/122 (p = 1.000). Permanent pacemaker implantation occurred in 6/70 (8.6%) versus 2/122 (1.6%) (unadjusted p = 0.053) and paravalvular leak of any grade in 7/69 (10.1%) versus 8/121 (6.6%); with eight and fifteen events respectively, neither endpoint could be estimated with useful precision; these non-significant comparisons should not be read as evidence of comparable safety. Within a single access, team and era, the rapid-deployment prosthesis was associated with substantially shorter operative times, lower gradients and shorter hospital stay, with similar observed in-hospital mortality (1/70 versus 1/122); with only two deaths overall this comparison cannot establish equivalence. These findings describe operative efficiency rather than demonstrated clinical superiority, and the safety comparisons remain underpowered.