Aortic and/or mitral valve surgery in patients with pulmonary hypertension performed via a minimally invasive approach

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.