August 19, 2004Annals of Surgery274 citationsOpen Access
View Full PaperOne Thousand Minimally Invasive Valve Operations
Key Result
Minimally invasive valve surgery for isolated aortic and mitral valve disease demonstrated low operative mortality (2% for aortic, 0.2% for mitral) and excellent 6-year freedom from reoperation.
Study Design
Type
Observational (n=1,000)
Structured PICO
Do minimally invasive approaches for isolated aortic and mitral valve disease provide safe and durable outcomes?
P
Population
1,000 patients undergoing minimally invasive operations for isolated aortic and mitral valve disease, with follow-up to 6 years.
E
Exposure
Minimally invasive valve operations (upper ministernotomy, lower sternotomy, right parasternal, or right thoracotomy) for valve repair or replacement
O
Outcome
Operative mortality, late mortality, and freedom from reoperation at 6 yearshard clinical
Minimally invasive valve surgery for isolated aortic and mitral valve disease is associated with very low operative mortality and excellent long-term freedom from reoperation.
Abstract
OBJECTIVE: We sought to evaluate the potential benefits of minimally invasive approaches for treatment of isolated aortic and mitral valve disease. METHODS: From 7/96 to 04/03, we performed 1000 minimally invasive valve operations: 526 aortic (AV) procedures (64 years; mean, 25-95) and 474 mitral (MV) procedures (58 years; mean, 17-90). RESULTS: In the AV group, an upper ministernotomy was used in 492/526 patients (93%) and a right parasternal approach in 34 (7%). Sixty-three patients had reoperative aortic valve replacements. In the MV group lower sternotomy was used in 260/474 (55%), right parasternal in 200/474 (42%), and a right thoracotomy in 14 patients. MV repair was performed in 416 and MV replacement in 58 patients. Operative mortality was 12/526 (2%) in the AV and 1/474 (0.2%) in the MV group. Freedom from reoperation at 6 years was 99% and 95% in the AV and MV group, respectively. Late mortality was 5% in the AV and 3% in the MV group, respectively. CONCLUSIONS: Minimally invasive valve surgery can be performed at very low levels of morbidity and mortality, with results equal to or better than conventional techniques. All forms of valve repair and replacement operations can be performed. Long-term survival and freedom from reoperation are excellent.