Feasibility and safety of totally endoscopic Bentall procedure via right anterior mini-thoracotomy: Early experience

Objectives: Minimally invasive aortic root surgery via right anterolateral minithoracotomy (RAMT) is a developing technique that has shown promise in selected patient populations. This study reports our initial experience with the totally endoscopic Bentall procedure performed through RAMT using 3-dimensional visualization. Methods: We retrospectively analyzed clinical data from 35 patients who underwent a totally endoscopic Bentall procedure via RAMT between March 2023 and July 2025. Collected variables included operative and aortic crossclamp time, cardiopulmonary bypass duration, ventilation time, postoperative drainage, intensive care unit and hospital length of stay, as well as midterm follow-up outcomes. Results: The mean patient age was 61.3 ± 12.0 years, with 74.3% being male. Mean procedure time was 153.0 minutes (interquartile range [IQR], 140.0-183.0), with mean cardiopulmonary bypass and aortic crossclamp times of 116.6 ± 26.7 minutes and 85.0 ± 22.5 minutes, respectively. No conversions to sternotomy or re-thoracotomies were required. Mean chest drainage in the first 24 hours was 629.3 ± 240.8 mL. Mean ventilation time was 7.0 ± 5.9 hours, median intensive care unit stay was 24.0 hours (IQR, 21.0-38.0), and hospital stay was 6.0 days (IQR, 5.0-8.0). Thirty-day mortality was zero. All patients survived during the median follow-up period of 18 months, and cosmetic results were consistently excellent. Conclusions: The totally endoscopic Bentall procedure via RAMT is a feasible and safe minimally invasive technique in selected patients. When performed by experienced surgical teams in high-volume centers, this approach offers favorable operative and midterm outcomes without compromising safety or effectiveness.