One thousand minimally invasive valve operations: early and late results.
OBJECTIVE
We sought to evaluate the potential benefits of minimally invasive approaches for treatment of isolated aortic and mitral valve disease.


METHODS
From 7/96 to 04/03, we performed 1000 minimally invasive valve operations: 526 aortic (AV) procedures (64 years; mean, 25-95) and 474 mitral (MV) procedures (58 years; mean, 17-90).


RESULTS
In the AV group, an upper ministernotomy was used in 492/526 patients (93%) and a right parasternal approach in 34 (7%). Sixty-three patients had reoperative aortic valve replacements. In the MV group lower sternotomy was used in 260/474 (55%), right parasternal in 200/474 (42%), and a right thoracotomy in 14 patients. MV repair was performed in 416 and MV replacement in 58 patients. Operative mortality was 12/526 (2%) in the AV and 1/474 (0.2%) in the MV group. Freedom from reoperation at 6 years was 99% and 95% in the AV and MV group, respectively. Late mortality was 5% in the AV and 3% in the MV group, respectively.


CONCLUSIONS
Minimally invasive valve surgery can be performed at very low levels of morbidity and mortality, with results equal to or better than conventional techniques. All forms of valve repair and replacement operations can be performed. Long-term survival and freedom from reoperation are excellent.
Mihaljevic
Tomislav
T
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Cohn
Lawrence H
LH
Unic
Daniel
D
Aranki
Sary F
SF
Couper
Gregory S
GS
Byrne
John G
JG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D013249:Sternum / Q000601:surgery; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000379:methods* / Q000401:mortality; D013908:Thoracotomy