Right Anterior Minithoracotomy Approach for Aortic Valve Replacement

Aortic stenosis is the most prevalent valvular heart condition necessitating surgical intervention, with full sternotomy (FS) traditionally being the standard approach for surgical aortic valve replacement (SAVR). However, many patients undergoing AVR are high-risk candidates, leading to the development and evolution of transcatheter aortic valve replacement (TAVR) as an alternative treatment. Not all patients qualify for TAVR due to anatomical limitations, making minimally invasive AVR a potential solution for certain cases to avoid the risks associated with sternotomy. The most common MIAVR techniques include ministernotomy and upper hemisternotomy, but right anterior minithoracotomy (RAMT) may offer additional benefits by completely avoiding sternotomy. RAMT has also proven to be more cost-effective than sternum-based techniques.  However, RAMT AVR presents technical challenges and a steeper learning curve, which may hinder its widespread adoption. This article provides a comprehensive overview of RAMT AVR, including patient selection, preoperative considerations, and clinical outcomes compared to sternotomy AVR and ministernotomy AVR. Overall, the article highlights the potential of RAMT AVR in managing aortic stenosis while calling for further research to strengthen the evidence base.