One Thousand Minimally Invasive Valve Operations

TLDR

The study evaluated the benefits of minimally invasive approaches for isolated aortic and mitral valve disease by performing 1,000 operations. The authors performed 526 aortic and 474 mitral valve procedures via minimally invasive techniques—upper ministernotomy for most aortic cases and lower sternotomy, right parasternal, or right thoracotomy for mitral—along with 416 repairs, 58 replacements, and 63 reoperative aortic replacements. Operative mortality was 2% for aortic and 0.2% for mitral, 6‑year freedom from reoperation reached 99% and 95%, late mortality was 5% and 3%, and overall morbidity and outcomes were equal to or better than conventional techniques.

Abstract

We sought to evaluate the potential benefits of minimally invasive approaches for treatment of isolated aortic and mitral valve disease.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).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.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.