Partial Upper Sternotomy versus Right Thoracotomy with Central Cannulation for Surgical Aortic Valve Replacement

Abstract

This study compared surgical aortic valve replacement (SAVR) via partial upper sternotomy (PUS) and right anterolateral thoracotomy (RALT) with central aortic cannulation regarding intraoperative perfusion parameters, transfusion requirements, and early postoperative outcomes.

We retrospectively analyzed 380 patients who underwent isolated SAVR via PUS or RALT. Propensity score matching yielded 107 matched pairs. All patients underwent central aortic and peripheral venous cannulation.

Cardiopulmonary bypass, aortic cross-clamp, and total operative times were longer in the RALT group, whereas reperfusion time was shorter (all p < 0.001). Transfusion requirements for packed red blood cells, fresh-frozen plasma, and platelet concentrates did not differ between groups. Cell salvage volume was generally lower in the RALT group after matching. Intubation times were comparable between groups. Intensive care unit (ICU) length of stay and total postoperative hospital stay were shorter in the RALT group (p < 0.001 and p = 0.008, respectively). Peak catecholamine requirements were lower in the RALT group (p = 0.005). Rates of permanent pacemaker implantation and pulmonary, wound, and urinary tract infections did not differ. In-hospital mortality was 0.9% in the PUS group; no deaths occurred in the RALT group.

Both approaches achieved low in-hospital mortality and comparable complication rates. Despite longer operative times, RALT was associated with shorter ICU and hospital stays and lower vasopressor requirements. RALT with central aortic cannulation is a safe and feasible alternative to PUS for minimally invasive aortic valve surgery.