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Right thoracotomy for aortic valve replacement in the adolescents with bicuspid aortic valve

Raffaele Giordano1, Massimiliano Cantinotti2, Giuseppe Comentale1, Luigi Di Tommaso1, Gabriele Iannelli11, Emanuele Pilato1, Gaetano Palma1

1 Department of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
2 Tuscany Foundation G. Monasterio CNR‐ Regione Toscana, Massa and Pisa, Italy

* Corresponding Author: Raffaele Giordano, University of Naples Federico II, Via Pansini 5, Napoli 80131, Italy. Email:

Congenital Heart Disease 2019, 14(2), 162-166.


Background: In this study, we compared our experience about early and midterm follow‐up outcomes for right anterolateral minithoracotomy (RAMT) vs full sternot‐ omy (FS) in surgical aortic valve replacement (AVR) among adolescents with bicuspid aortic valve (BAV).
Methods: Patients were retrospectively enrolled from January 2008 to December 2017. Inclusion criteria were patients with BAV who had to undergo to AVR. They were divided in two groups: RAMT and FS. The choice of RAMT was based on indi‐ vidual surgeon’s preferences or when expressly requested by patient that was in‐ formed of nonconventional approach.
Results: We enrolled 61 patients, 23 in RAMT group and 38 in FS group. The mean age was 15.6 ± 1.7 years for RAMT group and 16.1 ± 1.5 years for FS group (P = .23). The RAMT group had a higher prevalence of female gender (P = .04). The patients in the RAMT group had longer cardiopulmonary bypass (115.2 ± 18.5 vs 102.2 ± 16.5 min; P = .006) and cross‐clamp time (78.6 ± 18.1 vs 74.3 ± 15.2 min; P = .01). No pa‐ tients required intraoperative conversion to FS. No differences were found in venti‐ lation times, postoperative intensive care unit (ICU), and hospital length of stay for both groups. Follow‐up echocardiograms were available for all patients at median of 5.2 years (range 0.5‐9.6 years, median 5.4 years for RAMT and 5.1 for FS) and no patient required reoperation for aortic prosthesis malfunction.
Conclusions: Our study shows that RAMT is safe and effective as FS. Although the RAMT operation takes slightly more operation time, it is not associated with major adverse effects.


Cite This Article

Giordano, R., Cantinotti, M., Comentale, G., Tommaso, L. D., Iannelli, G. et al. (2019). Right thoracotomy for aortic valve replacement in the adolescents with bicuspid aortic valve. Congenital Heart Disease, 14(2), 162–166.

This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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