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Outcomes of Minimally Invasive Valve Surgery in Patients
With Chronic Obstructive Pulmonary Disease
Objective: We compared the outcomes of minimally invasive valve surgery with median sternotomy in patients with chronic obstructive pulmonary disease.
Methods: We retrospectively reviewed 2846 consecutive cardiac operations performed at our institution between January 2005 and September 2010, and identified 165 patients with chronic obstructive pulmonary disease who underwent isolated valve surgery. COPD was defined as mild, when the forced expiratory volume in 1 minute (FEV1) was ≥80% of predicted, and/or the patient was on chronic inhaled or oral bronchodilator therapy. Moderate COPD was when the FEV1 was ≥ 50% to < 80% of predicted, and/or the patient was on chronic steroid therapy aimed at the lung disease, and severe COPD was defined as having an FEV1 <50% of predicted, and/or a room air pO2 < 60 mmHg or a room air pCO2 > 50 mmHg. In-hospital mortality, STS-defined composite complication rates, intensive care unit and total hospital length of stay of those who had a minimally invasive approach were compared with those of patients that underwent a standard median sternotomy.
Results: Of 165 patients, 100 (60.6%) underwent a minimally invasive approach, and 65 had a median sternotomy. Baseline characteristics did not differ between the two groups.  The mean age was 71 ± 11 years for the minimally invasive group, and 68 ± 12 years for the median sternotomy group, (p=0.31).   In-hospital mortality was 1 (1%) in the minimally invasive group, and 3 (5%) in the median sternotomy group, p=0.14.   STS-defined composite post-operative complications were significantly reduced in the minimally invasive group (30% versus 54%, p=0.002). The median intensive care unit length of stay was 47 hours (IQR 40-70) versus 73 (IQR 51-112), p<0.001, and the median post-operative length of stay was 6 days (IQR 5-9) versus 9 (IQR 7-13), p<0.001, for the minimally invasive, and the median sternotomy groups, respectively.   
Conclusions: Minimally invasive valve surgery in patients with chronic obstructive pulmonary disease is associated with excellent short term results, and should be considered an option in these patients.