Minithoracotomy Versus Sternotomy for Aortic Valve Replacement: Outcomes from a Latin American Comparative Study

TL;DR

This study compares two surgical approaches for aortic valve replacement and finds similar mortality rates between them in Latin American hospitals.

Contribution

The study demonstrates that minimally invasive surgery for aortic valve replacement is as safe as traditional methods in middle-income countries.

Findings

Operative mortality rates were similar between minithoracotomy and full sternotomy.

Post-operative complications like pacemaker insertion and atrial fibrillation were more common with minithoracotomy.

Five-year survival estimates were comparable between the two surgical approaches.

Abstract

We conducted a study comparing full sternotomy (FS) and minithoracotomy (MT) for aortic valve replacement (AVR). The primary end-point was determining all-cause mortality and other variables according to the VARC 3 Consortium.

Retrospective investigation from January 2017 to December 2024 in 2 referral centres in Peru. We selected 142 patients who were submitted to isolated AVR through MT and 772 through FS. We used unmatched analysis and a propensity score matching (PSM) for matched analysis.

In the unmatched analysis, operative mortality for MT was similar (MT: 2.1% vs FS: 1.6%, P: .391), stroke rate in the MT group was 2.1% and in the FS group 1% (P: .278), pacemaker insertion was more common in the MT group (MT: 3.5% vs FS: 0.5%, P < .001) as well as post-operative atrial fibrillation (POAF) (19% vs 9.2%, P < .001). After a PMS, operative mortality was similar (MT: 1/108, 0.9% vs FS: 3/108, 2.8%, P: .314); as well as, pacemaker insertion (MT: 2.8% vs FS: 0%, P: .081), stroke (MT: 1.9% vs FS: 0%, P: .162) or POAF (MT: 15.7%, FS: 8.33%, P: .086). At follow-up, PMS analysis showed a similar 5-year survival estimates (MT: 97.6%, IC 95%: 90.7%-99.4% and for FS: 94%, IC 95%: 85.2%-97.6%, P: .103).

Isolated AVR through MT or FS has similar operative and follow-up mortality rates. It is possible to implement a minimally invasive cardiac surgery (MICS) program with good results in middle-income countries.

Aortic valve (AV) disease is the most common valvar heart disease and a major public health problem; in Latin America (LATAM), the prevalence is estimated at 100 cases per 103 and the incidence at 5 cases per 103 inhabitants (year 2019).

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