title: Early and late outcomes of 1000 minimally invasive aortic valve operations.
abstract: OBJECTIVE
  Minimal access cardiac valve surgery is increasingly utilized. We report our 11-year experience with minimally invasive aortic valve surgery.
  
  
  METHODS
  From 07/96 to 12/06, 1005 patients underwent minimally invasive aortic valve surgery. Early and late outcomes were analyzed.
  
  
  RESULTS
  Median patient age was 68 years (range: 24-95), 179 patients (18%) were 80 years or older, 130 patients (13%) had reoperative aortic valve surgery, 86 (8.4%) had aortic root replacement, 62 (6.1%) had concomitant ascending aortic replacement, and 26 (2.6%) had percutaneous coronary intervention on the day of surgery (hybrid procedure). Operative mortality was 1.9% (19/1005). The incidences of deep sternal wound infection, pneumonia and reoperation for bleeding were 0.5% (5/1005), 1.3% (13/1005) and 2.4% (25/1005), respectively. Median length of stay was 6 days and 733 patients (72%) were discharged home. Actuarial survival was 91% at 5 years and 88% at 10 years. In the subgroup of the elderly (> or =80 years), operative mortality was 1.7% (3/179), median length of stay was 8 days and 66 patients (37%) were discharged home. Actuarial survival at 5 years was 84%. There was a significant decreasing trend in cardiopulmonary bypass time, the incidence of bleeding, and operative mortality over time.
  
  
  CONCLUSIONS
  Minimal access approaches in aortic valve surgery are safe and feasible with excellent outcomes. Aortic root replacement, ascending aortic replacement, and reoperative surgery can be performed with these approaches. These procedures are particularly well-tolerated in the elderly.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Ramanan
authors.initials: R
authors.lastname: Umakanthan
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
authors.forename: Ralph Morton
authors.initials: RM
authors.lastname: Bolman
authors.forename: Prem S
authors.initials: PS
authors.lastname: Shekar
authors.forename: Frederick Y
authors.initials: FY
authors.lastname: Chen
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Couper
authors.forename: Sary F
authors.initials: SF
authors.lastname: Aranki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000534:rehabilitation / Q000592:standards* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000534:rehabilitation / Q000592:standards / Q000639:trends; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome