MinimallyInvasiveAorticValveReplacement：Long-termOutcomesIn15-yearSingleCenterExperience

Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center, Nagoya Daiichi Hospital, Japan

Authors : Masayoshi Tokoro, Kazuo Nomura, Tsubasa Yazawa, Riku Kato, Shogo Maeda, Toshiaki Ito

Background

At our institution, MIAVR was introduced in 2011, and totally endoscopic AVR via a right lateral thoracotomy has since become the standard (first-line) procedure for isolated aortic valve replacement.

The aim of this study was to evaluate the early postoperative outcomes and mid- to long-term outcomes of MIAVR performed via a right lateral thoracotomy and to assess the validity and feasibility of this surgical approach.

Methods

Between January 2011 and December 2025, a total of 562 patients underwent MIAVR at our institution, including 209 procedures performed under direct vision and 353 totally endoscopic procedures. Early outcomes included perioperative mortality and major adverse cardiac and cerebrovascular events (MACCE). Mid- to long-term outcomes included all-cause mortality and valve-related events.

Results

The mean patient age was 71.1 ± 12.4 years, with 265 male patients (47.2%). Aortic stenosis was present in 345 patients (61.4%). 55 patients (9.8%) underwent concomitant valve and/or aortic surgeries. The mean operative time was 206.6 ± 61.1 minutes, and the mean aortic cross-clamp time was 90.1 ± 31.1 minutes.

Thirty-day mortality occurred in one patient (0.2%), and MACCE occurred in nine patients (1.6%). No early postoperative reoperations were required. The overall survival rates at 1, 5, 10, and 12 years were 97.8%, 89.5%, 75.7%, and 73.5%, respectively. Freedom from valve-related events at the same time points was 99.4%, 98.2%, 89.0%, and 82.1%, respectively.

Among the 20 patients who required reintervention, 11 were treated with transcatheter aortic valve replacement (TAVR). Of them, the mean age of these patients was 76.2 years, and structural valve deterioration of externally mounted bioprosthetic valves accounted for 82% of the causes.

Conclusions

Early and mid- to long-term outcomes of MICS AVR performed via a right anterolateral thoracotomy were excellent. This approach may represent a standard surgical option for isolated aortic valve replacement in experienced centers.