title: Minimally invasive aortic valve replacement: the Leipzig experience.
abstract: BACKGROUND
  Minimally invasive techniques are progressively challenging traditional approaches in cardiothoracic surgery. Minimally invasive aortic valve replacement (AVR) has become a routine procedure at our institution.
  
  
  METHODS
  We retrospectively analyzed all patients undergoing minimally invasive isolated AVR between January 2003 and March 2014, at our institution. Mean follow-up was 4.7±4.3 years (range: 0-18 years) and was 99.8% complete.
  
  
  RESULTS
  There were 1,714 patients who received an isolated minimally invasive AVR. The mean (± SD) patient age was 65±12.8 years, ejection fraction 60%±12% and log EuroSCORE 5.3%±5.1%. Mean cross-clamp time was 58±18 minutes and mean cardiopulmonary bypass (CPB) time was 82.9±26.7 minutes. Thirty-day survival was 97.8%±0.4%, and 69.4%±1.7% at 10-years. The multivariate analysis revealed age at surgery [P=0.016; odds ratio (OR), 1.1], length of surgery time (P=0.002; OR, 1.01), female gender (P=0.023; OR, 3.54), preoperative myocardial infarction (MI) (P=0.006; OR, 7.87), preoperative stroke (P=0.001; OR, 13.76) and preoperative liver failure (P=0.015; OR, 10.28) as independent risk factors for mortality. Cox-regression analysis revealed the following predictors for long term mortality: age over 75 years (P<0.001; OR, 3.5), preoperative dialysis (P<0.01; OR, 2.14), ejection fraction less than 30% (P=0.003; OR, 3.28) and urgent or emergency operation (P<0.001; OR, 2.3).
  
  
  CONCLUSIONS
  Minimally invasive AVR can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable.
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Lehmann
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Denis R
authors.initials: DR
authors.lastname: Merk
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Etz
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schroeter
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Oberbach
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Madlen
authors.initials: M
authors.lastname: Uhlemann
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoellriegel
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Haensig
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Sergey
authors.initials: S
authors.lastname: Leontyev
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Garbade
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.affiliation: 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
keywords: Minimal invasive; aortic valve replacement (AVR); long-term survival; short-term survival; surgical technique