Right Anterolateral Thoracotomy vs. Partial Upper Sternotomy for Surgical Aortic Valve Replacement: A Propensity-Matched Analysis of Postoperative Recovery

All articles of this category (opens in new window) Background: Minimally invasive surgical aortic valve replacement (SAVR) is increasingly performed to reduce surgical trauma and enhance recovery. Two common approaches, partial upper sternotomy (PUS) and right anterolateral thoracotomy (RALT), with central aortic cannulation, offer distinct procedural benefits. This study compared intraoperative and postoperative outcomes between these techniques. Methods: We retrospectively analyzed 380 patients who underwent SAVR between 2011 and 2023. Propensity score matching (PSM) resulted in 107 well-balanced pairs of patients undergoing either PUS or RALT. All procedures used central aortic and peripheral venous cannulation. Primary endpoints included cardiopulmonary bypass time, cross-clamp time, and overall operation duration. Secondary endpoints included transfusion requirements, vasoactive medication dosage, intubation duration, intensive care unit (ICU) stay, total hospital stay, and major postoperative complications. Results: Bypass, cross-clamp, and operation times were longer in the RALT group but did not reach statistical significance ( p > 0.05). No intraoperative or postoperative complications were attributable to aortic cannulation in either group. Blood product transfusions did not differ significantly across cohorts ( p > 0.05). Perioperative cell saver use was lower in RALT (350 mL vs. 340 mL, p = 0.5. Maximum catecholamine dosage was significantly reduced in RALT (10 mcg/minutes vs. 15 mcg/minutes, p = 0.005). Duration of intubation was similar ( p > 0.05). ICU stay (24 hours ( IQR: 6.24 vs. IQR: 24.32), p < 0.001) and total postoperative hospital stay (8 days (IQR: 7, 9) vs. 9 days (IQR: 7, 11), p = 0.008) were significantly shorter in RALT patients. One death occurred in the PUS group (0.2%). Rates of pacemaker implantation, wound infection, pulmonary complications, and urinary tract infections were comparable (all p > 0.05). Conclusion: Both PUS and RALT yield favorable outcomes in SAVR. Despite slightly longer intraoperative times, RALT with central aortic cannulation was associated with reduced catecholamine use and shorter ICU and hospital stays, underscoring its safety and potential recovery advantages. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany