Routine minimally invasive aortic valve procedures.
BACKGROUND
Due to the lack of objective evidence supporting the advantages and early technical difficulties, minimally invasive aortic valve procedures were performed on a highly selective rather than routine basis.


METHODS
From September 1997 to February 1999, one surgeon routinely used upper or transverse minimally invasive sternotomy to perform 46 consecutive cases of aortic valve procedures (M), whereas two other surgeons performed 40 aortic valve procedures through a conventional sternotomy (C).


RESULTS
More time consuming and technically demanding surgeries were done in M. There was one death in each group. Aortic clamp time was longer in M (93+/-40 vs 59+/-24 min, P=0.001). There were no differences in operating time, pump time, intubation duration, bleeding and intensive care unit stay. The advantages of minimally invasive aortic valve operation included better postoperative ejection fraction (58+/-17 vs 51+/-10%, P=0.04), decreased pain score (3+/-2 vs 5+/-2, P=0.004), less transfusion (19 vs 55%, P=0.02), shorter duration of chest tube drainage, and cosmetically more acceptable surgical wound (6.8+/-2.2 vs 5.2+/-2.0, P=0.018). From our series, we could not find any negative effects of minimal access surgery.


CONCLUSIONS
Our study demonstrated that aortic valve surgeries could be performed routinely by the minimally invasive approach with a high degree of effectiveness and safety.
Lee
J W
JW
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center and University of Ulsan, 388-1 Pungnap-Dong, Songpa-Gu, 138-736, Seoul, South Korea. jwlee@www.amc.seoul.kr
Lee
S K
SK
Choo
S J
SJ
Song
H
H
Song
M G
MG
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D002637:Chest Pain / Q000209:etiology; D016009:Chi-Square Distribution; D002921:Cicatrix / Q000209:etiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D010149:Postoperative Pain; D011182:Postoperative Care; D011183:Postoperative Complications; D013249:Sternum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome