A technique of minimally invasive aortic valve replacement: an alternative to transcatheter aortic valve replacement (TAVR)

Minimally invasive aortic valve surgery is increasingly being adopted by cardiac surgeons worldwide (1), in which aortic valve replacement (AVR) plays a central role. Since the first reported AVR occurred through a right thoracotomy in 1993 (2), a variety of minimally invasive techniques have been described, including right mini-thoracotomy (RT), mini-sternotomy (MS), transarterial and transcatheter AVR (TAVR). Among which, RT procedure has shown superior results in terms of mortality, morbidities and patient satisfaction when compared with traditional full sternotomy and MS approach (3,4). However, for patients with high surgical risk for advanced age and multiple comorbidities, RT approach will increase the cross-clamp and cardiopulmonary bypass (CPB) time for its limited exposure and working space. Furthermore, groin incision and rib division of this procedure also limits its application in these patients when compared with another minimally invasive method—TAVR. Nowadays, sutureless valves have evoked more and more interest, which has opened up a new field which is quite competitive with traditional AVR and TAVR. By quick implantation of the prosthesis which requires minimal suturing and tying, the cross-clamp and CPB time have been largely reduced, making this technique a competitive option for high risk patients. Here we present a surgical technique of minimally invasive AVR via RT using sutureless prosthesis without rib division and groin incision, providing a new surgical technique which not only can compare with the highly minimally invasive TAVR procedure, but also offer a more durable valve than TAVR