The Establishment of a Transaxillary Minimally Invasive Aortic Valve Replacement Program: Considerations and First Patient Outcomes

Background: As minimally invasive and alternative approaches for aortic valve repair gain increased popularity, this trial reports on outcomes of an established program using the underreported novel right transaxillary (rTX) access for aortic valve surgery. Methods: Between June 2023 and May 2025, a total of 22 patients underwent aortic valve surgery using the rTx approach (female: n = 14 (63.6%); age: 64.5 (60.0–70.0) years; EuroSCORE II: 0.9 (0.6–1.1)), mainly for aortic valve stenosis (n = 17 (77.3%)) and primarily with cannulation of the right groin (n = 21 (95.5%)) for cardiopulmonary bypass (CPB). Results: The median aortic clamp time was 78.5 (74.8–90.3) minutes, and the median extracorporeal circulation time was 143.0 (134.8–178.3) minutes. One (4.5%) patient underwent acute surgical revision via sternotomy due to bleeding from the aortotomy, while aortic root replacement was successfully performed. One (4.5%) patient experienced a stroke, and one (4.5%) received a pacemaker for high-grade atrioventricular block. Regarding CPB and surgical access site complications, one (4.5%) patient had a postoperative hematoma at the right groin, and one (4.5%) had a surgically revised thoracic hematoma. The median intensive care unit stay was 1.0 (1.0–2.3) days. No patient died during the median follow-up period of 6.0 (3.0–16.5) months. Conclusion: Minimally invasive aortic valve surgery by rTX is feasible for a variety of valve pathologies, revealing good clinical outcomes even at the start of such a program. The low learning curve at experienced centers for minimally invasive cardiac surgery encourages other centers to adopt this approach as the potential future standard for aortic valve surgery.