{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:17:19Z","timestamp":1789496239993,"version":"build-2803163510"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The transaxillary concept for minimally invasive cardiac surgery-aortic valve replacement is a new and versatile approach with nearly no visible scars. Due to its novelty, available data in literature are scarce. This study reports clinical outcomes of 1000 consecutive patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Between 2019 and 2023, 4394 patients underwent elective isolated aortic valve procedures, with 2958 (67.5%) transcatheter aortic valve implantation\u2019s and 1436 patients surgical aortic valve replacement\u2019s (32.5%). Within this period, 1st consecutive 1000 transaxillary isolated minimally invasive cardiac surgery-aortic valve replacement were enrolled. Endocarditis, redo\u2019s or combined procedures were excluded. Mean age was 67.9\u2009\u00b1\u20098.3\u2009years, STS-PROM 1.39\u2009\u00b1\u20092.89% and EuroScore II 1.65\u2009\u00b1\u20091.12%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Use of the transaxillary access increased from 18.7% (2019) to 97.8% (2023). Mean procedure time was 127\u2009\u00b1\u200931\u2009min, and average cross-clamp time was 43\u2009\u00b1\u200914\u2009min. Used prostheses were rapid deployment (81.1%), sutured biologic (14.5%) or sutured mechanical valves (4.1%). Conversion rate was 1.9%. No patient died intraoperatively. Thirty-day major adverse cardiac and cerebrovascular event was 1.9% including 0.9% mortality, 0.8% perioperative stroke and 0.6% myocardial infarction. Multivariate factors for major adverse cardiac and cerebrovascular event are intraoperative conversion [OR 1.08 (1.00\u20131.16); P\u2009=\u20090.04], intraoperative transfusions [OR 1.21 (1.07\u20131.38); P\u2009&amp;lt;\u20090.01] and respiratory failure [OR 1.39 (1.30\u20131.49); P\u2009&amp;lt;\u20090.01]. Corresponding factors for mortality are diabetes on insulin [OR 1.02 (1.00\u20131.04); P\u2009=\u20090.03], pure aortic regurgitation for primary indication [OR 1.03 (1.01\u20131.05); P\u2009&amp;lt;\u20090.01], intraoperative conversion [OR 1.11 (1.07\u20131.16); P\u2009&amp;lt;\u20090.01], renal failure [OR 1.08 (1.05\u20131.10); P\u2009&amp;lt;\u20090.01] and respiratory failure [OR 1.22 (1.17\u20131.26); P\u2009&amp;lt;\u20090.01].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Transaxillary minimally invasive cardiac surgery-aortic valve replacement is a safe, effective and cosmetically convincing method for surgical aortic valve replacement, having the potential for &amp;gt;95.0% minimally invasive cardiac surgery rate in selected patients.<\/jats:p>\n               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