title: Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients.
abstract: OBJECTIVE
  This study assessed comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients.
  
  
  METHODS
  From January 1, 2000, to December 31, 2008, 1005 patients underwent isolated mitral valve surgery at our institution. Patients ≥ 75-years-old were included in analysis (sternotomy, n = 105; minimally invasive, n = 70). Clinical outcomes included bypass and crossclamp time, length of hospitalization, morbidity, and mortality. To assess resource use, total hospital costs and discharge location were analyzed. Three standardized inpatient functional status outcomes were also assessed.
  
  
  RESULTS
  The minimally invasive approach was associated with a 9.2-minute longer crossclamp time (P = .037) and a 25.2-minute longer bypass time (P < .001). Minimally invasive surgery was associated with a 3.1-day shorter hospitalization (P = .033). There were no significant differences in rate of major postoperative complications (P = .085) or long-term survival (P = .60). Minimally invasive approach was associated with a $6721 lower median cost of hospitalization (P = .007) and more common discharge to home, routinely or with a health aide, rather than to rehabilitation (P = .021). Minimally invasive patients achieved faster rates of independent ambulation (P = .039) and independent sit-to-stand activity (P = .003), although there were no differences in time to independent stair climbing (P = .31).
  
  
  CONCLUSIONS
  Among elderly patients, minimally invasive mitral valve surgery is associated with slightly longer crossclamp and bypass times but with equivalent morbidity and mortality and shorter hospitalization, decreased resource use, and improved postoperative functional status.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Iribarne
authors.forename: Rachel
authors.initials: R
authors.lastname: Easterwood
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Chan
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D005260:Female; D006349:Heart Valve Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D009519:New York City; D010351:Patient Discharge / Q000191:economics; D018579:Patient Selection; D020127:Recovery of Function; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome