Aortic valve replacement surgery: comparison of outcomes in matched sternotomy and PORT ACCESS groups.
BACKGROUND
In the past decade, minimally invasive approaches have been developed for aortic valve surgery. We reviewed our data to determine if the use of the PORT ACCESS technique has improved hospital morbidity and mortality.


METHODS
Data were collected on 90 patients who had a replacement of their aortic valve using PORT ACCESS procedures (PORT ACCESS aortic valve replacement [PAVR]). This group was then matched 1:4 to a control group having aortic valve replacement surgery using a standard sternotomy approach.


RESULTS
The two groups had no statistically significant differences in preoperative risk factors. The perioperative and 30-day outcomes from the matched AVR and PAVR groups showed no mortalities in the PAVR group and 3.1% in the AVR group. Mean length of stay was shorter for PAVR patients (7.2 +/- 5.0 days; median 6 days) compared with the mean stay in the sternotomy group (8.5 +/- 9.5 days; median 6 days), PAVR patients also had statistically significant shorter intensive care unit stays, and time on ventilator. The number of patients needing ventilator support postoperatively was significantly lower in the PORT ACCESS group. Cross-clamp and perfusion times were longer in the PAVR group. No other morbidity was significantly different between groups, except for postoperative tamponade (higher in PAVR group).


CONCLUSIONS
In this analysis of matched patients, the patients having aortic valve replacement using PORT ACCESS procedures, spent a shorter time in the intensive care unit and had less need for postoperative ventilator usage (both number of patients using a ventilator and the mean time of use) in comparison with patients undergoing conventional sternotomy.
Brinkman
William T
WT
Medical City Dallas Hospital, Dallas, Texas, USA.
Hoffman
William
W
Dewey
Todd M
TM
Culica
Dan
D
Prince
Syma L
SL
Herbert
Morley A
MA
Mack
Michael J
MJ
Ryan
William H
WH
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy; D016896:Treatment Outcome