title: Function of the Respiratory System in Elderly Patients After Aortic Valve Replacement.
abstract: OBJECTIVE
  To compare the function of the respiratory system after aortic valve replacement through median sternotomy (AVR) or the minimally invasive right anterior minithoracotomy (RAT-AVR) approach among elderly (aged≥75 years) patients.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  The study included 65 elderly patients scheduled for RAT-AVR and 82 for standard AVR.
  
  
  METHODS
  Pulmonary function tests (PFT) were performed preoperatively, 1 week, 1 month, and 3 months after surgery. In addition, respiratory complications were analyzed.
  
  
  RESULTS
  Respiratory complications occurred in 12.3% of patients in the RAT-AVR group and 18.3% of patients in the AVR group (p = 0.445). Mechanical ventilation time in the intensive care unit was 7.7±3.6 hours for RAT-AVR patients and 9.7±5.4 hours for AVR patients (p = 0.003). Most PFT were worse in the AVR group than in the RAT-AVR group when performed 1 week after surgery. After 1 month, forced expiratory volume in the first second, vital capacity, and total lung capacity differed significantly in favor of the RAT-AVR group (p = 0.002, p<0.001, and p = 0.001, respectively). After 3 months, the PFT parameters still had not returned to preoperative values, but the differences were no longer significant between the RAT-AVR and AVR groups. The multivariable median regression analysis demonstrated that RAT-AVR surgery was a key factor in a patient's higher postoperative PFT parameter values.
  
  
  CONCLUSIONS
  RAT-AVR surgery resulted in shorter postoperative mechanical ventilation time and improved the recovery of pulmonary function in elderly patients, but it did not reduce the incidence of pulmonary complications when compared with surgery performed through a median sternotomy.
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland. Electronic address: jstolinski@gmail.com.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Stoliński
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Plicner
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Bogusław
authors.initials: B
authors.lastname: Gawęda
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Musiał
authors.affiliation: Department of Statistics, Cracow University of Economics, Cracow, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.affiliation: Department of Anaesthesia and Pain Management, Toronto General Hospital, Department of Anaesthesia, University of Toronto, Toronto, Canada.
authors.forename: Marcin
authors.initials: M
authors.lastname: Wąsowicz
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Andres
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
authors.forename: Bogusław
authors.initials: B
authors.lastname: Kapelak
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000503:physiopathology*; D012129:Respiratory Function Tests / Q000706:statistics & numerical data; D012137:Respiratory System / Q000503:physiopathology*; D056346:Sternotomy / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: cardiac surgery in elderly patients; minimally invasive aortic valve surgery; respiratory function after cardiac surgery