title: Outcomes of minimally invasive valve surgery versus median sternotomy in patients age 75 years or greater.
abstract: BACKGROUND
  Advanced age is a major predictor of poor outcome in patients undergoing valve surgery. We hypothesized that elderly patients who underwent minimally invasive valve surgery for aortic or mitral valve disease would do better when compared with those undergoing the standard median sternotomy.
  
  
  METHODS
  We retrospectively reviewed 2,107 consecutive heart operations at our institution and identified 203 patients, age 75 years or greater, who underwent isolated mitral or aortic valve surgery. Outcomes of those who had minimally invasive valve surgery through a right minithoracotomy were compared with those who had a median sternotomy.
  
  
  RESULTS
  Of the 203 patients, 119 (59%) underwent a minimally invasive approach, while 84 (41%) had a median sternotomy. The median postoperative length of stay was 7 days (interquartile range [IQR] 6 to 10) versus 12 days (IQR 9 to 20), p less than 0.001, and intensive care unit length of stay was 52 hours (IQR 44 to 93) versus 119 hours (IQR 57 to 193), p less than 0.001 for minimally invasive and median sternotomy, respectively. In-hospital mortality was 2 (1.7%) versus 8 (9.5%, p=0.01 and composite postoperative morbidity and mortality occurred in 25 (21%) versus 38 (45.2%), p less than 0.001, in minimally invasive versus median sternotomy, respectively. The difference was driven by the following: a lower incidence of acute renal failure, 1 (0.8%) versus 14 (16.7%), p<0.001; prolonged intubation 23 (19.3%) versus 32 (38.1%), p=0.003; wound infections 1 (0.8%) versus 5 (6%), p=0.034; and death.
  
  
  CONCLUSIONS
  Minimally invasive surgery for isolated valve lesions in elderly patients yields a lower morbidity and mortality when compared with median sternotomy and should be considered when such individuals require valve surgery.
authors.affiliation: Division of Cardiothoracic Surgery, Mount Sinai Medical Center and Heart Institute, Miami Beach, Florida 33140, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lamelas
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sarria
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Andres M
authors.initials: AM
authors.lastname: Pineda
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D056346:Sternotomy; D016896:Treatment Outcome