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Objective: Minimally invasive surgery is more technically demanding and is associated with longer cardiopulmonary bypass times than is median sternotomy. On the other hand, a minimally invasive approach has been associated with better outcomes in high-risk patients. We explored the outcomes of minimally invasive double valve surgery compared with a median sternotomy approach.
Methods: We retrospectively reviewed 2634 consecutive cardiac operations in our institution between January 2006 and February 2011, and identified 74 patients who had minimally invasive double valve surgery. Their outcomes were compared to those of 66 patients that had their surgery via a median sternotomy.
Results: The mean age of the minimally invasive group was 71.8 ± 11.6 years, and 70.7 12.5 years for the median sternotomy group, p=0.62. There were no statistically significant differences in baseline characteristics between groups. The EuroSCORE was 8.6 ±4.2 and 8.9 ± 4.3 for the minimally invasive and median sternotomy group, respectively. The in-hospital mortality was 1 (1.4%) in the minimally invasive group and 8 (12%) in the median sternotomy group, p=0.009. The median intensive care unit length of stay was 70 hours (IQR 46-127) versus 112 (IQR 70-210), p=<0.001, and the median postoperative length of hospital stay was 8 days (IQR 7-12) versus 13 days (IQR 10-18), p<0.001, for the minimally invasive and the median sternotomy group, respectively. Composite post-operative complications, defined as the presence of post-operative renal failure, prolonged ventilation (>24 hours), re-intubation, deep wound infection or sepsis, bleeding requiring re-exploration, stroke, or in-hospital death, were 42% in the minimally invasive and 62% in the median sternotomy group, p=0.017.
Conclusions: Minimally invasive double valve surgery is associated with a significant reduction in morbidity and mortality, with lower resource utilization when compared with a median sternotomy approach.