ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Impact Of Minimally Invasive Mitral Valve Surgery In The Elderly Population
Johannes Petersen, Shiho Naito, Christian Detter, Hermann Reichenspurner, Lenard Conradi, Evaldas Girdauskas.
University Heart Center Hamburg, Hamburg, Germany.

Objective
Due to demographic changes an increasing number of elderly patients present with mitral valve disease. Minimally-invasive cardiac surgery has evolved to become standard therapy for several cardiac pathologies at specialized centers. The goal of this study was to compare this technique to the conventional access via full median sternotomy in the elderly population.
Methods:
This retrospective analysis included 330 consecutive patients receiving a mitral valve repair between 2012 and 2016 at the age of 70 or older. 193 patients underwent concomitant procedures while isolated mitral valve surgery and/or ablation was performed in 137 patients. Anterolateral minithoracotomy was utilized in 46 cases (group I) while 91 patients were operated via full median sternotomy (group II) – serving as our study population.
Results:
Patients in group I were significantly younger compared to group II (I: 73±2 vs. II: 76±4; p<0.001). Further preoperative characteristics were similar between the two groups. EuroSCORE II (I: 1.68±1.58 vs II: 4.21±2.91; p<0.001) and STS-Score (I: 1.33±0.64 vs II: 2.10±1.19; p<0.001) were significantly higher in group II. Cardiopulmonary bypass time (I: 175±51 vs II: 125±38 minutes; p<0.001) and duration of procedure (I: 256±67 vs. II: 231±69 minutes; p=0.044) were significantly longer in group I. Duration of intensive care unit (I: 2±1.2 vs II: 3±2.7 days; p=0.003) and length of hospital stay (I: 7.02±1.7 vs. II: 9.8±5.5 days; p<0.001) were shorter in group I, respectively. Perioperative stroke occurred in 4 patients in group II; none in group I. In-hospital mortality was 0% group I in comparison to 1.09% in group II. Postoperative complications involved a postoperative drain due to pneumothorax (I: 4.3%; II: 2.2%; p=0.602); postoperative pacemaker implantation (I: 0%; II: 12.1%; p=0.016); re-thoracotomy due to bleeding (I: 3 patients - 2 requiring sternotomy; I: 3 patients) and wound healing disorder (I: 0%; II: 4.4%; p=0.300).
Conclusion:
Minimally invasive mitral valve surgery is safe and feasible in elderly patients above 70 with significant shorter ICU and in-hospital stay. Given the appropriate institutional expertise in minimally-invasive mitral valve surgery, such procedures can be safely performed in patients > 70 without in-hospital mortality.


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