# 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.

## Key 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).