title: Aortic and/or mitral valve surgery in patients with pulmonary hypertension performed via a minimally invasive approach.
abstract: Pulmonary hypertension (PH) in the setting of left-sided valvular heart disease is common, and significantly increases the risk of perioperative morbidity and mortality in patients undergoing aortic and/or mitral valve surgery. Minimally invasive valve surgery is associated with a decreased incidence of perioperative complications, and a faster recovery, when compared with conventional sternotomy. In the present study, the outcomes of 569 patients with PH who underwent minimally invasive aortic and/or mitral valve surgery were analysed. The operative mortality was 3.5%, and postoperative strokes occurred in 1.4%. The mean intensive care unit and hospital length of stays were 50 ± 14 h and 7 ± 1 days, respectively. Patients with severe PH (mean pulmonary artery pressure ≥40 mmHg) had a longer duration of postoperative ventilation and intensive care unit length of stay, when compared with mild/moderate PH, and similar clinical outcomes. In conclusion, a minimally invasive approach to aortic and/or mitral valve surgery in patients with PH is safe and feasible, and may be considered as an alternative to conventional median sternotomy.
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Gosain
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Maiteder
authors.initials: M
authors.lastname: Larrauri-Reyes
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA cmihos@mgh.harvard.edu.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Esteban
authors.initials: E
authors.lastname: Escolar
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve; Minimally invasive surgery; Mitral valve; Pulmonary hypertension; Right thoracotomy