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

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

METHODS Retrospective investigation from January 2017 to December 2024 in two referral centers 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.

RESULTS In the unmatched analysis, operative mortality for MT was similar (MT: 2.1% vs FS: 1.6%, p: 0.391), stroke rate in the MT group was 2.1% and in the FS group 1% (p : 0.278), pacemaker insertion was more common in the MT group (MT : 3.5% vs FS : 0.5%, p < 0.001) as well as post-operative atrial fibrillation (POAF) (19% vs 9.2%, p < 0.001). After a PMS, operative mortality was similar (MT: 1/108, 0.9% vs FS: 3/108, 2.8%, p: 0.314); as well as, pacemaker insertion (MT : 2.8% vs FS: 0%, p: 0.081), stroke (MT : 1.9% vs FS: 0%, p: 0.162) or POAF (MT: 15.7%, FS: 8.33%, p : 0.086). At follow-up; PMS analysis showed a similar five-year survival estimates (MT: 97.6%, IC95%: 90.7-99.4% and for FS: 94%, IC95%: 85.2-97.6, p : 0.103).

CONCLUSIONS 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.