title: Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair.
abstract: OBJECTIVE
  This study compares the quality of valve replacement and repair performed through minimally invasive incisions as compared to the standard operation for aortic and mitral valve replacement.
  
  
  BACKGROUND
  With the advent of minimally invasive laparoscopic approaches to orthopedic surgery, urology, general surgery, and thoracic surgery, it now is apparent that standard cardiac valve operations can be performed through very small incisions with similar approaches.
  
  
  METHODS
  Eighty-four patients underwent minimally invasive aortic (n = 41) and minimally invasive mitral valve repair and replacement (n = 43) between July 1996 and April 1997. Demographics, procedures, operative techniques, and postoperative morbidity and mortality were calculated, and a subset of the first 50 patients was compared to a 50-patient cohort who underwent the same operation through a conventional median sternotomy. Demographics, postoperative morbidity and mortality, patient satisfaction, and charges were compared.
  
  
  RESULTS
  Of the 84 patients, there were 2 operative mortalities both in class IV aortic patients from multisystem organ failure. There was no operative mortality in the patients undergoing mitral valve replacement or repair. The operations were carried out with the same accuracy and attention to detail as with the conventional operation. There was minimal postoperative bleeding, cerebral vascular accidents, or other major morbidity. Groin cannulation complications primarily were related to atherosclerotic femoral arteries. A comparison of the minimally invasive to the conventional group, although operative time and ischemia time was higher in minimally invasive group, the requirement for erythrocytes was significantly less, patient satisfaction was significantly greater, and charges were approximately 20% less than those in the conventional group.
  
  
  CONCLUSIONS
  Minimally invasive aortic and mitral valve surgery in patients without coronary disease can be done safely and accurately through small incisions. Patient satisfaction is up, return to normality is higher, and requirement for postrehabilitation services is less. In addition, the charges are approximately 20% less. These results serve as a paradigm for the future in terms of valve surgery in the managed care environment.
authors.affiliation: Brigham and Women's Hospital, Department of Surgery, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Cohn
authors.forename: D H
authors.initials: DH
authors.lastname: Adams
authors.forename: G S
authors.initials: GS
authors.lastname: Couper
authors.forename: D P
authors.initials: DP
authors.lastname: Bichell
authors.forename: D M
authors.initials: DM
authors.lastname: Rosborough
authors.forename: S P
authors.initials: SP
authors.lastname: Sears
authors.forename: S F
authors.initials: SF
authors.lastname: Aranki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D013249:Sternum / Q000601:surgery; D016896:Treatment Outcome