Comparison of recent clinical effects between right anterior mini- thoracotomy and full sternotomy used in Bentall surgery.

BACKGROUND

The Bentall procedure remains the gold standard for treating aortic root pathologies. However, the conventional full sternotomy (FS) approach is associated with sternal complications and prolonged recovery times. The right anterior mini-thoracotomy (RAMT), a minimally invasive alternative, offers reduced trauma and preserves sternal integrity, but its safety and efficacy require further evaluation. This study aims to compare the short-term outcomes of RAMT and FS in Bentall procedures.

METHODS

This single-center retrospective study included all patients who underwent Bentall surgery between May 2022 and December 2024. Using a 1:2 matched design to balance baseline characteristics, 16 patients were included in the RAMT group and 32 in the FS group. The primary endpoint was the 30-day incidence of major adverse cardiac and cerebrovascular events (MACCEs). Secondary endpoints included cardiopulmonary bypass time (CPBT), postoperative complications, and short-term follow-up outcomes.

RESULTS

The aortic cross-clamp time was significantly longer in the RAMT group compared to the FS group (146±22.4 vs. 130±27.9 min, P=0.03), though no significant differences were found in CPBT or total operative time. Intraoperative blood loss was significantly lower in the RAMT group (median 300 vs. 500 mL, P=0.002). No significant differences were observed between the two groups in 30-day MACCEs, mechanical ventilation time, postoperative length of stay, total hospitalization expenditures, or incidence of major postoperative complications. Short-term follow-up (median 12 months) showed that all patients, except for one case of prosthetic valve endocarditis (PVE) in the RAMT group, survived with improved cardiac function.

CONCLUSIONS

In patients selected according to strict criteria, the RAMT approach for Bentall surgery was associated with longer aortic cross-clamp time but significantly reduced intraoperative blood loss, while demonstrating comparable perioperative safety and short-term efficacy to the conventional FS approach. RAMT is a feasible minimally invasive option, although its long-term outcomes warrant further validation through larger sample sizes and extended follow-up.