Clinical outcomes of right anterior mini-thoracotomy aortic valve surgery: A propensity score-matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Zeyuan , CUI Chenyi , LI Jiahui , CHEN Xianjie , LI Zhao , QI Zhenchang , WANG Sheng ,  CHENG Zhaoyun

Department of Cardiac Surgery, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, 451464, P. R. China;

Corresponding author：

CHENG Zhaoyun, Email: Chengzhy@zzu.edu.cn

Keywords：

Aortic insufficiency; aortic valve replacement; minimally invasive cardiac surgery; propensity score-matching analysis

DOI：

10.7507/1007-4848.202312044

Video：

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Objective To compare perioperative outcomes of minimally invasive aortic valve surgery by a right anterior minithoracotomy (RAMT) and conventional sternotomy. Methods A retrospective analysis of patients who underwent isolated aortic valve surgeries in our hospital between May 2021 and August 2023 with a minimal incision via the right anterior minithoracotomy approach (a RAMT group) or conventional incision via the full sternotomy approach (a conventional group). A propensity score-matching analysis was performed to balance preoperative data and compare perioperative data of the two groups. Results There were 58 patients in the RAMT group, including 46 males and 12 females with an average age of 52.0±14.1 years; 128 patients were enrolled in the conventional group, including 87 males and 41 females with an average age of 60.0±12.4 years. After propensity-score matching, there were 51 patients in each group. The RAMT patients had a longer mean operation time, cross-clamping time and cardiopulmonary bypass time compared to the conventional group (all P<0.05). However, ICU length of stay, ventilator-assisted time and postoperative hospital stay were significantly shorter in the RAMT group (all P<0.05). Patients in the RAMT group had lower 24 hour chest drain output (P<0.05). RAMT was associated with a trend towards a lower blood transfusion rate in comparison to the sternotomy group, although this was not statistically significant (P>0.05). The occurrence of all-cause death, stroke and perioperative complications was also similar in both groups (P>0.05). Conclusion Right anterior mini-thoracotomy is associated with less trauma, faster recovery, less postoperative drainage, and shorter hospital stay than conventional approach. Right anterior mini-thoracotomy in patients undergoing isolated aortic valve surgery is a safe approach and can be performed by a wide range of surgeons.

1.	《中国心血管健康与疾病报告2022》编写组. 《中国心血管健康与疾病报告2022》概述. 中国心血管病研究, 2023, 21(7): 577-600.
2.	Ueno G, Ohno N. Aortic valve approaches in the era of minimally invasive cardiac surgery. Surg Today, 2020, 50(8): 815-820.
3.	Bonacchi M, Dokollari A, Parise O, et al. Ministernotomy compared with right anterior minithoracotomy for aortic valve surgery. J Thorac Cardiovasc Surg, 2023, 165(3): 1022-1032.
4.	Olds A, Saadat S, Azzolini A, et al. Improved operative and recovery times with mini-thoracotomy aortic valve replacement. J Cardiothorac Surg, 2019, 14(1): 91.
5.	Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat, 2011, 10(2): 150-161.
6.	Gasparovic I, Artemiou P, Hudec V, et al. Long-term outcomes following minimal invasive versus conventional aortic valve replacement: A propensity match analysis. Bratisl Lek Listy, 2017, 118(8): 479-484.
7.	Bakhtiary F, Salamate S, Amer M, et al. Comparison of right anterior mini-thoracotomy versus partial upper sternotomy in aortic valve replacement. Adv Ther, 2022, 39(9): 4266-4284.
8.	Roussakis A, Gavalaki A, Contrafouris C, et al. Minimally invasive aortic valve replacement: Initial experience of the 1st Cardiac Surgery Department of Onassis Cardiac Surgery Center. A propensity score-adjusted analysis. Hellenic J Cardiol, 2020, 61(5): 346-348.
9.	颜磊, 陈庆伟, 陈国庆等. 经右胸第3肋间小切口与胸骨正中切口行单纯主动脉瓣置换术疗效比较的回顾性队列研究. 中国胸心血管外科临床杂志, 2023, 30(4): 540-545.
10.	吴保星, 张红强, 冯宇佳, 等. 经右胸前外侧肋间小切口行微创主动脉瓣置换术的临床效果. 中国当代医药, 2022, 29(35): 57-61.
11.	尹力, 陈文, 邱志兵, 等. 右胸小切口与常规正中切口瓣膜置换术的手术效果及术后早期并发症对比. 中国临床研究, 2022, 35(10): 1396-1400.
12.	姜兆磊, 梅举, 丁芳宝, 等. 微创右胸切口与常规胸骨正中切口主动脉瓣置换术的对比研究. 中国胸心血管外科临床杂志, 2014, 21(6): 762-765.
13.	Glauber M, Miceli A, Gilmanov D, et al. Right anterior minithoracotomy versus conventional aortic valve replacement: A propensity score matched study. J Thorac Cardiovasc Surg, 2013, 145(5): 1222-1226.
14.	Solinas M, Bianchi G, Chiaramonti F, et al. Right anterior mini-thoracotomy and sutureless valves: The perfect marriage. Ann Cardiothorac Surg, 2020, 9(4): 305-313.
15.	Mohamed MA, Ding S, Ali Shah SZ, et al. Comparative evaluation of the incidence of postoperative pulmonary complications after minimally invasive valve surgery vs. full sternotomy: A systematic review and meta-analysis of randomized controlled trials and propensity score-matched studies. Front Cardiovasc Med, 2021, 8: 724178.
16.	Pojar M, Karalko M, Dergel M, et al. Minimally invasive or sternotomy approach in mitral valve surgery: A propensity-matched comparison. J Cardiothorac Surg, 2021, 16(1): 228.
17.	Grant SW, Hickey GL, Modi P, et al. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart, 2019, 105(10): 783-789.
18.	Mkalaluh S, Szczechowicz M, Dib B, et al. Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: A retrospective propensity-score matched analysis. Peer J, 2018, 6: e4810.
19.	Paparella D, Fattouch K, Moscarelli M, et al. Current trends in mitral valve surgery: A multicenter national comparison between full-sternotomy and minimally-invasive approach. Int J Cardiol, 2020, 306: 147-151.
20.	Seitz M, Goldblatt J, Paul E, et al. Minimally invasive aortic valve replacement via right anterior mini-thoracotomy: Propensity matched initial experience. Heart Lung Circ, 2019, 28(2): 320-326.
21.	Pojar M, Vojacek J, Karalko M, et al. Single-center experience with minimally invasive mitral operations through right minithoracotomy. Ann Thorac Cardiovasc Surg, 2019, 25(1): 18-25.
22.	Chivasso P, Bruno VD, Farid S, et al. Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The mitral surgery in octogenarians study. J Thorac Cardiovasc Surg, 2018, 155(4): 1474-1482.
23.	Liang L, Ma X, Kong Q, et al. Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: A single-center retrospective cohort study. Cardiovasc Diagn Ther, 2022, 12(3): 378-388.
24.	Abud B, Saydam O, Engin AY, et al. Outcomes of aortic valve replacement via right anterior minithoracotomy and central cannulation versus conventional aortic valve replacement in obese patients. Braz J Cardiovasc Surg, 2022, 37(6): 875-882.
25.	Plestis K, Orlov O, Shah VN, et al. Facilitating technologies in minimally invasive aortic valve replacement: A propensity score analysis. Interact Cardiovasc Thorac Surg, 2018, 27(2): 202-207.
26.	Klein P, Klop IDG, Kloppenburg GLT, et al. Planning for minimally invasive aortic valve replacement: Key steps for patient assessment. Eur J Cardiothorac Surg, 2018, 53(suppl_2): ii3-ii8.

1. 《中国心血管健康与疾病报告2022》编写组. 《中国心血管健康与疾病报告2022》概述. 中国心血管病研究, 2023, 21(7): 577-600.
2. Ueno G, Ohno N. Aortic valve approaches in the era of minimally invasive cardiac surgery. Surg Today, 2020, 50(8): 815-820.
3. Bonacchi M, Dokollari A, Parise O, et al. Ministernotomy compared with right anterior minithoracotomy for aortic valve surgery. J Thorac Cardiovasc Surg, 2023, 165(3): 1022-1032.
4. Olds A, Saadat S, Azzolini A, et al. Improved operative and recovery times with mini-thoracotomy aortic valve replacement. J Cardiothorac Surg, 2019, 14(1): 91.
5. Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat, 2011, 10(2): 150-161.
6. Gasparovic I, Artemiou P, Hudec V, et al. Long-term outcomes following minimal invasive versus conventional aortic valve replacement: A propensity match analysis. Bratisl Lek Listy, 2017, 118(8): 479-484.
7. Bakhtiary F, Salamate S, Amer M, et al. Comparison of right anterior mini-thoracotomy versus partial upper sternotomy in aortic valve replacement. Adv Ther, 2022, 39(9): 4266-4284.
8. Roussakis A, Gavalaki A, Contrafouris C, et al. Minimally invasive aortic valve replacement: Initial experience of the 1st Cardiac Surgery Department of Onassis Cardiac Surgery Center. A propensity score-adjusted analysis. Hellenic J Cardiol, 2020, 61(5): 346-348.
9. 颜磊, 陈庆伟, 陈国庆等. 经右胸第3肋间小切口与胸骨正中切口行单纯主动脉瓣置换术疗效比较的回顾性队列研究. 中国胸心血管外科临床杂志, 2023, 30(4): 540-545.
10. 吴保星, 张红强, 冯宇佳, 等. 经右胸前外侧肋间小切口行微创主动脉瓣置换术的临床效果. 中国当代医药, 2022, 29(35): 57-61.
11. 尹力, 陈文, 邱志兵, 等. 右胸小切口与常规正中切口瓣膜置换术的手术效果及术后早期并发症对比. 中国临床研究, 2022, 35(10): 1396-1400.
12. 姜兆磊, 梅举, 丁芳宝, 等. 微创右胸切口与常规胸骨正中切口主动脉瓣置换术的对比研究. 中国胸心血管外科临床杂志, 2014, 21(6): 762-765.
13. Glauber M, Miceli A, Gilmanov D, et al. Right anterior minithoracotomy versus conventional aortic valve replacement: A propensity score matched study. J Thorac Cardiovasc Surg, 2013, 145(5): 1222-1226.
14. Solinas M, Bianchi G, Chiaramonti F, et al. Right anterior mini-thoracotomy and sutureless valves: The perfect marriage. Ann Cardiothorac Surg, 2020, 9(4): 305-313.
15. Mohamed MA, Ding S, Ali Shah SZ, et al. Comparative evaluation of the incidence of postoperative pulmonary complications after minimally invasive valve surgery vs. full sternotomy: A systematic review and meta-analysis of randomized controlled trials and propensity score-matched studies. Front Cardiovasc Med, 2021, 8: 724178.
16. Pojar M, Karalko M, Dergel M, et al. Minimally invasive or sternotomy approach in mitral valve surgery: A propensity-matched comparison. J Cardiothorac Surg, 2021, 16(1): 228.
17. Grant SW, Hickey GL, Modi P, et al. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart, 2019, 105(10): 783-789.
18. Mkalaluh S, Szczechowicz M, Dib B, et al. Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: A retrospective propensity-score matched analysis. Peer J, 2018, 6: e4810.
19. Paparella D, Fattouch K, Moscarelli M, et al. Current trends in mitral valve surgery: A multicenter national comparison between full-sternotomy and minimally-invasive approach. Int J Cardiol, 2020, 306: 147-151.
20. Seitz M, Goldblatt J, Paul E, et al. Minimally invasive aortic valve replacement via right anterior mini-thoracotomy: Propensity matched initial experience. Heart Lung Circ, 2019, 28(2): 320-326.
21. Pojar M, Vojacek J, Karalko M, et al. Single-center experience with minimally invasive mitral operations through right minithoracotomy. Ann Thorac Cardiovasc Surg, 2019, 25(1): 18-25.
22. Chivasso P, Bruno VD, Farid S, et al. Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The mitral surgery in octogenarians study. J Thorac Cardiovasc Surg, 2018, 155(4): 1474-1482.
23. Liang L, Ma X, Kong Q, et al. Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: A single-center retrospective cohort study. Cardiovasc Diagn Ther, 2022, 12(3): 378-388.
24. Abud B, Saydam O, Engin AY, et al. Outcomes of aortic valve replacement via right anterior minithoracotomy and central cannulation versus conventional aortic valve replacement in obese patients. Braz J Cardiovasc Surg, 2022, 37(6): 875-882.
25. Plestis K, Orlov O, Shah VN, et al. Facilitating technologies in minimally invasive aortic valve replacement: A propensity score analysis. Interact Cardiovasc Thorac Surg, 2018, 27(2): 202-207.
26. Klein P, Klop IDG, Kloppenburg GLT, et al. Planning for minimally invasive aortic valve replacement: Key steps for patient assessment. Eur J Cardiothorac Surg, 2018, 53(suppl_2): ii3-ii8.

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