COMPARATIVE ANALYSIS OF THE IMMEDIATE OUTCOMES OF AORTIC VALVE REPLACEMENT VIA RIGHT ANTERIOR MINI-THORACOTOMY AND J-STERNOTOMY: PROPENSITY SCORE MATCHING

Highlights

A single-center study of two surgical approaches using a pseudo-randomization method revealed the advantages of mini-thoracotomy while maintaining a high level of clinical safety.

Aim. To conduct a comparative analysis of the immediate outcomes of aortic valve replacement (AVR) performed via right anterior mini-thoracotomy (RAMT) and J-sternotomy (JC) within a single center.

Methods. From January 2024 to April 2025, a total of 47 AVR procedures were performed using minimally invasive approaches. Of these, 17 patients underwent RAMT and 30 underwent JC. The mean age in the RAMT group was 63 [45; 68] years, compared with 67 [62; 70] years in the JC group (p = 0.040). After propensity score matching, 17 matched pairs of patients with similar baseline characteristics were identified.

Results. Cardiopulmonary bypass (CPB) and aortic cross-clamp times in the RAMT group were 124 [98; 146] min and 89.06 ± 23.85 min, respectively, compared with shorter durations in the JC group: 101 [90; 115] min and 73.20 ± 18.86 min (p = 0.008). In both groups, biological prostheses were more frequently used, with a predominance in the JC group (80%). The median intraoperative blood loss in the RAMT group was 300 mL, significantly lower than 500 mL in the JC group (p < 0.001). Postoperative blood loss within the first 24 hours was also lower in the RAMT group: 150 [100; 200] mL versus 302 [205; 375] mL in the JC group (p < 0.001). The smaller intra- and postoperative blood loss corresponded with a lower need for blood transfusions in the RAMT group: 11.8% versus 43.3% in the JC group (p = 0.049). No statistically significant differences were found between the groups in terms of duration of mechanical ventilation, intensive care unit stay, or inotropic support. Similarly, no differences were observed in the incidence of adverse events.

Conclusion. Despite its technical complexity, RAMT is an effective and safe approach for aortic valve replacement, combining several positive effects such as reduced blood loss, decreased transfusion requirements, and faster patient recovery.

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