A 16-year experience in minimally invasive aortic valve replacement: context for the changing management of aortic valve disease.
OBJECTIVE
The aim of this study was to evaluate short- and long-term morbidity and mortality in patients with aortic valve disease who had minimally invasive aortic valve replacement (AVR) through upper hemisternotomy.


METHODS
From July 1996 to June 2012, a total of 1639 patients underwent minimally invasive aortic valve surgery (AVR). Patient data were extracted from hospital electronic records after institutional review board approval. Outcomes of interest included postoperative complication rates, perioperative mortality, and long-term survival.


RESULTS
The mean age was 67 years (SD, 14 years; range, 22-95 years). Of the total cohort, 211 (13%) underwent reoperative AVR. Postoperatively, 2.3% (37/1639) had reoperations to correct bleeding, 2.7% (44/1639) had strokes, 20.4% (334/1639) had new-onset atrial fibrillation, and 1.5% (24/1639) required permanent pacemakers. Only 34% (571/1639) of the patients received packed red blood cells. The median discharge was on day 6 (5-8), and 72.2% of the patients (1184/1639) were discharged home. Operative mortality was 2.9% (48/1639), and long-term survival at 1, 5, 10, and 15 years was 96%, 93%, 92%, and 92%, respectively. Operative mortality was 5.7% (12/208) for the reoperative patients.


CONCLUSIONS
The upper hemisternotomy approach for AVR is safe and reliable, especially for patients undergoing reoperations and those older than 80 years.
From the Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA.
Igor
I
Gosev
Tsuyoshi
T
Kaneko
Siobhan
S
McGurk
Scott R
SR
McClure
Ann
A
Maloney
Lawrence H
LH
Cohn
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D019468:Disease Management; D005260:Female; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000601:surgery*; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D014481:United States / Q000453:epidemiology; D055815:Young Adult