Background: A minimally invasive surgery (MIS) for aortic valve replacement (AVR) using sutureless Perceval (Liva Nova) aortic bioprosthesis through a right anterior mini-thoracotomy (RAMT) approach. It reduces mortality and morbidity with acceptability early outcome.

Methods: Between January  2021 and December 2023, 130 patients had underwent  isolated AVR with Perceval bioprosthesis through a RAMT approach in the second intercostal space. The prosthesis sizes implanted were: S (n=10), M (n=80), L (n=40) and XL (n=0). Mean age was 65±4 years, patients were male (73%) and Euro SCORE II was 5.9%±8.4%.

Results: The 30-day mortality was 0%. Cardiopulmonary bypass (CPB) and aortic cross-clamp times were 82.6±35.8 and 51.3±20.5 minutes respectively. In two patients, early moderate paravalvular leakage appeared as a result of incomplete expansion of the sutureless valve due to oversizing of the bioprosthesis, requiring reoperations at two with sutured aortic bioprosthesis implantation. Permanent pacemaker implantation was in  (2%) patients. At the mean follow-up of 6months, survival was 99%, and mean trans-valvular pressure gradient was 11.9±4.3 mmHg.

Conclusions:  AVR with the Perceval bioprosthesis in a RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance.