title: Minimally invasive aortic valve replacement: Comparison of long-term outcomes.
abstract: BACKGROUND
  Minimally invasive aortic valve replacement tends to be performed in specialist centers. Little data exists with regard to long-term outcomes of the upper hemi-sternotomy technique. We sought to evaluate the short- and long-term outcomes of this procedure in our institution.
  
  
  METHODS
  Data were collected from our cardiac surgical database. We compared the outcomes of all patients who underwent minimally invasive aortic valve replacement with all who underwent conventional aortic valve replacement between July 1999 and December 2013. Propensity-matching analysis was performed to evaluate hospital outcomes.
  
  
  RESULTS
  There were 125 patients who underwent minimally invasive aortic valve replacement and 1446 who had conventional surgery. After propensity score matching, there were no differences in postoperative mortality or complications between the 2 groups. The only significant differences were longer bypass (62.69 ± 10.12 vs. 68.94 ± 14.79 min, p = 0.002) and crossclamp times (45.48 ± 8.08 vs. 52.30 ± 16.29 min, p < 0.001) in conventional surgery. Long-term survival after minimally invasive aortic valve replacement at 2, 6, and 10 years was 88% ± 3.0%, 79% ± 4.0%, and 66% ± 6.0%, respectively. Predictors of long-term survival were age, peripheral vascular disease, and low ejection fraction (p < 0.005).
  
  
  CONCLUSIONS
  Minimally invasive aortic valve replacement has similar hospital outcomes compared to conventional aortic valve replacement. The operation is quicker and does not confer any significant increase in complications or length of hospital stay. The long-term outcomes are favorable and justify its continued use by specialist surgeons in the United Kingdom.
authors.affiliation: Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK priyadariyaratnam@yahoo.co.uk.
authors.forename: Priyadharshanan
authors.initials: P
authors.lastname: Ariyaratnam
authors.affiliation: Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Loubani
authors.affiliation: Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Griffin
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D000069451:Long Term Adverse Effects / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Aortic valve insufficiency; Aortic valve stenosis; Heart valve prosthesis implantation; Minimally invasive surgical procedures; Treatment outcome