Open accessCardiac surgeryopenheart Consensus statement on aortic valve8replacement via an anterior rightminithoracotomy in the UKhealthcare settingHunaid A Vohra,1 M Yousuf Salmasi ,2 Fatemazahra Mohamed,3Monica Shehata,Bardia Bahrami,Massimo Caputo ,1 Ranjit Deshpande,5Vinayak Bapat,Toufan Bahrami,Inderpaul Birdi,'Joseph Zachariasen Heart:first published as 10.1136/openhrt-2022-To cite:Vohra HA Salmasi MY.ABSTRACT(or ministernotomy)has been a longerMohamed F.etal.ConsensusThe wide uptake of anterior right thoracotomy (ART)asestablished mode of MIAVR.Numerous trialsstatement on aortic valvean approach for aortic valve replacement (AVR)has beenand multicentre studies have compared MS002replacement via an anterior rightminithoracotomy in the UKlimited despite initial reports of its use in 1993.Comparedwith ministemotomy,finding several bene-healthcare setting.Open Heartwith median sternotomy,and even ministernotomy,ART isfits:lower ventilation time,62023;10:e002194.doi10.1136/considered to be less traumatic to the chest wall and topain scores,56intensive care unit (ICU)stay''and hospitalopenhrt-.2022-002194help facilitate quicker patient recovery.In this statement,a consensus agreement is outlined that describesstay.78 There is also evidence to suggest lowerthe potential benefits of the ART AVR.The technicaltransfusion requirement with MIAVR5 and aMarReceived 29 November 2022considerations that require specific attention are describedreducedvolume of bloodloss.6It isimportantAccepted 27 February 2023and the initiation of an ART programme at a UK centre isto note that two randomised control trials2023recommended through simulation and/or use of specialistdid not show any advantages with the upperinstruments in conventional cases.The use of soft tissuehemisternotomy (UHS)approach (Ministemretractors,peripheral cannulation,modified aortic clampingand MAVRIC).and the use of intraoperative adjuncts,such as suturelessIn comparison,the anterior right thoraDownloadedvalves and/or automated knot fasteners,are important tocotomy (ART)approach avoids any divisionCheck for updatesconsider in order to circumvent the challenges of minimalthe altered exposure via an ART.of the sternum whatsoever,and opts insteadfromAuthor(s)for theirA coordinated team-based approach that encouragesfor a smaller-6cm intercostal incision to theemployer(s))2023.Re-useownership of the programme by team members is critical.right of the stemum (figure 1).Being morehttp://permitted under CC BY-NC.NoA designated proctor/mentor is also recommended.Thetechnically challenging than ministemotomy,commercial re-use.See rightsorganisation of structured training and simulation,asthe outcomes of AVR via the ART approachand permissions.Publishedwell as planning the initial cases are important steps toby BMJ.have been limited to single centre studies,consider.Bristol Royal nfirmary,Bristol,although they demonstrate numerous bene-enheart.bmUKfits,including improved patient satisfaction2Surgery and
