Minimal access aortic valve replacement: effects on morbidity and resource utilization.
BACKGROUND
The aim of this study was to compare outcomes in patients undergoing minimal access versus conventional aortic valve replacement (AVR).


METHODS
We reviewed prospectively gathered data on all patients who were undergoing first-time AVR, with or without replacement of the ascending aorta, over a 1-year period at our institution.


RESULTS
A total of 176 patients underwent minimal access and 258 underwent conventional AVR. The conventional group was older, had more incidence of diabetes, and more aortic stenosis (all p < 0.05). Eight minimal access AVR patients (2%) required conversion to a complete sternotomy. Minimal access AVR patients had longer aortic crossclamp times than conventional AVR patients (60 +/- 22 vs 55 +/- 23 minutes, p = 0.03) but similar CPB times (93 +/- 38 vs 88 +/- 42 minutes, p = 0.20). Postoperative creatine kinase-MB levels were similar for the two groups. Total postoperative blood loss was significantly lower in the minimal access group, and these patients received less red blood cell and fresh frozen plasma transfusions. Minimal access AVR patients were less likely to have postoperative respiratory failure (3% vs 10%); they had shorter intensive care unit stays (3.7 +/- 5.4 vs 4.5 +/- 5.6 days) and shorter hospital stays (10 +/- 6 vs 12 +/- 7 days, all p < 0.05). Mortality was lower in patients undergoing minimal access surgery (3% vs 9%, p = 0.008) by univariate analysis. Multivariate predictors of mortality were age, hypertension, and CPB time.


CONCLUSIONS
Although patient selection may have influenced some of the observed differences between our patient groups, minimal access surgery appears to be associated with decreased morbidity and resource use when compared to conventional AVR.
Doll
Nicolas
N
Clinic for Heart Surgery, Heart Center, University of Leipzig, Germany. dolln@medizin.uni-leipzig.de
Borger
Michael A
MA
Hain
Joerg
J
Bucerius
Jan
J
Walther
Thomas
T
Gummert
Jan F
JF
Mohr
Friedrich W
FW
D001021:Aortic Valve / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007527:Isoenzymes / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology; D013906:Thoracoscopy
D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form