Anterior Right Thoracotomy for Rapid Deployment Aortic Valve Replacement

Abstract Background Minimally invasive aortic valve replacement via anterior right thoracotomy (ART) has shown to be safe and feasible. However, acceptance within the surgical community is low. Rapid deployment aortic valves may be a game-changer due to simplified surgical technique and shorter operative times. Therefore, the combination of advanced surgical techniques like the ART access with rapid deployment aortic valves was assessed within this study. Methods We retrospectively analyzed all patients undergoing ART with the Edwards Intuity valve system between 2011 and 2018. Patient data were collected prospectively in an ongoing, single center registry. Data analysis regarding valve-outcome was performed according to current guidelines. Results 165 patients underwent aortic valve replacement via the ART access with the Edwards Intuity valve system (73+/-9 years, 49% female, median EuroSCORE II 1.6 (0.6-10.6)). Median cardiopulmonary bypass time was 114 (61-310)min and median aortic cross clamp time was 80 (45-230)min. 30-day as well as in hospital mortality was 0.6% (n=1). Postoperative neurological events occurred in 3%, resulting in major neurological deficit in one patient. Intermediate and long-term survival was 99%, 98% and 93% after 6 months, 1 year and 3 years respectively. Conclusions Implantation of the Edwards Intuity valve system via ART is safe, feasible and reproducible. The overall results of this single center experience are excellent compared to contemporary series of both surgical (SAVR) as well as transcatheter aortic valve replacements (TAVR).