Port-access-assisted aortic valve replacement: a comparison of minimally invasive and conventional techniques.
BACKGROUND
A hybrid Port-Access (PA) approach to aortic valve surgery (MPAVR) was designed as a less invasive aortic valve operation. The approach combines components of Port-Access technology with conventional cardiac surgical techniques via a limited sternal incision. This technique is compared to conventional aortic vale replacement (CAVR) for safety and efficacy.


METHODS
One hundred eighty patients had aortic valve surgery between January 1, 2000, and June 30, 2004. Fifty-eight patients (32%) had primary isolated aortic valve replacement, 22 of those 58 patients (38%) underwent MPAVR procedures consisting of a limited inverted-T sternotomy, direct aortic cannulation, a percutaneous PA endocoronary sinus cardioplegia catheter, an endovent pulmonary artery catheter, and a percutaneous femoral endovenous return catheter. Thirty-six patients (62%) had aortic valve replacement by sternotomy and standard cardiopulmonary bypass techniques. The MPAVR and CAVR groups were compared for demographics and intraoperative and postoperative outcomes.


RESULTS
Age, obesity, diabetes, New York Heart Association classification, ejection fraction, and other patient characteristics were not significantly different between the groups. MPAVR patients had lower Society of Thoracic Surgery risk scores (3.1 versus 3.9; P = .277). MPAVR patients were more likely to receive a stentless valve (36% versus 11%; P = .042) and required longer operative times (237 min versus 189 min; P <.001). Postoperative complications were minimal and equivalent. A single mortality in the CAVR group resulted in an overall mortality of 1.7%.


CONCLUSIONS
This hybrid, less invasive PA-assisted approach to aortic valve surgery is safe and effective. A total sternotomy can be avoided in selected aortic valve patients. Results equivalent to CAVR can be expected with this minimal access operation.
Leshnower
Bradley G
BG
Harrison Department of Surgical Research, University of Pennsylvania School of Medicine, Philadelphia, USA.
Trace
Candace S
CS
Boova
Robert S
RS
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome