Minimally invasive port access surgery reduces operative morbidity for valve replacement in the elderly.
BACKGROUND
Although minimally invasive techniques for valvular surgery have rapidly come into widespread use, whether such an approach can be safely applied to elderly patients remains an open question. To help resolve this issue, we reviewed our experience with minimally invasive port access (MIPA) valve surgery in elderly patients and compared it to the results obtained with the standard sternotomy (STD) approach in the same age group.


METHODS
From January 1994 through December 1998, 370 consecutive patients at least 70 years of age underwent isolated aortic or mitral valve surgery at our institution. The standard sternotomy operative approach was used in 259 patients (mean age 77.5 years) and the minimally invasive port access approach was used in 111 patients (mean age 76.0; p=.006). A mitral valve procedure was performed more often in the MIPA patients than in the STD patients (49.5% vs. 35.9%; p < .001).


RESULTS
Hospital mortality was comparable in the two groups, 9.7% (25/259) in the STD group and 7.2% (8/111) in the MIPA group (p = .50), as was the incidence of many perioperative complications. The MIPA group, however, had a significantly lower incidence of sepsis or wound complications (1.8% vs 7.7%; p = .027), required less fresh frozen plasma transfusion (median 1.0 unit vs 2.0 units; p =.04), and had a shorter length of hospital stay (11.6 days vs 17.6 days; p = .001).


CONCLUSIONS
These results indicate that with appropriate surgical techniques the MIPA approach for isolated valve surgery can be safely applied to the elderly patient population with excellent results. In our initial experience the MIPA approach is associated with significantly less plasma transfusion, fewer postoperative complications, and shorter length of hospital stay.
Division of Cardiothoracic Surgery, Department of Surgery, New York University Medical School, New York, NY 10016, USA. grossi@cv.med.nyu.edu
E A
EA
Grossi
A C
AC
Galloway
G H
GH
Ribakove
P M
PM
Buttenheim
R
R
Esposito
F G
FG
Baumann
S B
SB
Colvin
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D018709:Statistics, Nonparametric; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome