Right Anterior Thoracotomy Aortic Valve Replacement: Operative Technique and Early Outcomes in 156 Consecutive Patients

Background: Right anterior thoracotomy aortic valve replacement (RAT-AVR) is an established minimally invasive alternative to conventional sternotomy; however, published series predominantly reflect late-experience data from specialised centres. Real-world outcomes during early adoption remain underreported. Methods: We describe a contemporary operative technique for RAT-AVR and report early outcomes from a consecutive single-surgeon cohort undergoing isolated surgical aortic valve replacement between 2015 and 2025. Pre-operative imaging protocols, cannulation strategies, myocardial protection techniques, and valve implantation methods are detailed. Peri-operative characteristics and early clinical outcomes were analysed using prospectively collected registry data. Results: A total of 156 consecutive patients underwent RAT-AVR. Median age was 70 years, and 72% were male. Peripheral femoral cannulation was used in 96% of cases. Median cardiopulmonary bypass and cross-clamp times were 109 and 79 minutes, respectively. Conversion to sternotomy occurred in two patients (1%). Thirty-day mortality was 1.3%. Rates of stroke (0%), acute kidney injury (3%), and reoperation for bleeding (4%) were low. A broad range of valve sizes (19–27 mm) and prosthesis types were implanted without limitation imposed by the approach. Conclusions: In this consecutive single-surgeon series, including the learning phase of adoption, RAT-AVR was integrated safely into routine practice with favourable early outcomes. This approach represents a reproducible and pragmatic minimally invasive option for isolated surgical aortic valve replacement.