Minimally invasive aortic valve surgery. A safe and useful technique beyond the cosmetic benefits.
OBJECTIVE
The aim of this study was to compare the in-hospital clinical outcomes of minimally invasive, isolated aortic valve replacement vs median sternotomy.


METHODS
Between 2005 and 2012, 615 patients underwent aortic valve replacement at a single institution, 532 by a median sternotomy (E group) and 83 by a J-shaped ministernotomy (M group).


RESULTS
No significant differences were found between the E and M groups in terms of age (69.27 [9.31] years vs 69.40 [10.24] years, respectively), logistic EuroSCORE (6.27 [2.91] vs 5.64 [2.17], respectively), size of implanted valve prosthesis (21.94 [2.04] mm vs 21.79 [2.01] mm, respectively), or the incidence of diabetes, hypercholesterolemia, high blood pressure, or chronic obstructive pulmonary disease. Mean cardiopulmonary bypass time was 102.90 (41.68) min for the E group vs 81.37 (25.41) min for the M group (P<.001). Mean cross-clamp time was 77.31 (29.20) min vs 63.45 (17.71) min for the S and M groups, respectively (P<.001). Mortality in the E group was 4.88% (26). There were no deaths in the M group (P<.05). The E group was associated with longer intensive care unit and hospital stays: 4.17 (5.23) days vs 3.22 (2.01) days (P=.045) and 9.58 (7.66) days vs 7.27 (3.83) days (P<.001), respectively. E group patients had more postoperative respiratory complications (42 [8%] vs 1 [1.2%]; P<.05). There were no differences when postoperative hemodynamic, neurologic, and renal complications, systemic infection, and wound infection were analyzed.


CONCLUSIONS
In terms of morbidity, mortality, and operative times, outcomes after minimally invasive surgery for aortic valve replacement are at least comparable to those achieved with median sternotomy. The length of the hospital stay was reduced by minimally invasive surgery in our single-institution experience. The retrospective nature of this study warrants further randomized prospective trials to validate our results.
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. Electronic address: feco_py@hotmail.com.
Federico A
FA
Paredes
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Sergio J
SJ
Cánovas
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Oscar
O
Gil
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Rafael
R
García-Fuster
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Fernando
F
Hornero
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Alejandro
A
Vázquez
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Elio
E
Martín
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Armando
A
Mena
Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Juan
J
Martínez-León
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008136:Longevity; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D056346:Sternotomy; D016896:Treatment Outcome
Aortic valve; Cirugía; ICU; Minimally invasive; Mínimamente invasiva; Surgery; Válvula aórtica; intensive care unit