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Outcomes of Minimally Invasive versus Median Sternotomy in Patients Undergoing Double Valve Surgery
Maria J. Salas, Orlando Santana, Francisco Y. Macedo, Gerson Valdez, Gervasio Lamas, Joseph Lamelas.
Mount Sinai Heart Institute, Miami Beach, FL, USA.

OBJECTIVE: We aimed to compare the outcomes of patients undergoing elective double valve surgery via a minimally invasive approach with those who had a standard median sternotomy.
METHODS: We retrospectively reviewed all heart surgeries performed at our institution from December 2005 to December 2011, and identified 197 patients who underwent primary double-valve surgery. The outcomes of those who had minimally invasive valve surgery through a right minithoracotomy were compared with those who had a median sternotomy.
RESULTS: Of the 197 patients, 117 (59%) underwent a minimally invasive approach, while 80 (41%) had a median sternotomy. The baseline characteristics were similar between the groups. The in-hospital mortality in the minimally invasive group was 2% (1/117) versus 10% (8/80) in the median sternotomy group, (p=0.009). The number of patients who received blood products was 83 (71%) in the minimally invasive group, and 78 (98%) in the median sternotomy group, p <0.01. The median intensive care unit length of stay was 70 hours (IQR 46-135) in the minimally invasive group, and 114 (IQR 70-214) in the median sternotomy group, (p<0.001). The post-operative hospital length of stay was less in the minimally invasive group: 12 ± 12 days versus 18 ± 16 days, p=0.003. The post-operative complications were 66 (56%) in the minimally invasive group and 62 (78%) in the median sternotomy group, p=0.002; with the difference being driven by a reduction in the incidence of sepsis of 3 (2%) versus 9 (11%), p=0.01, and post-operative atrial fibrillation of 15 (13%) versus 24 (30%), p=0.003 in the minimally invasive group and the median sternotomy group, respectively.
CONCLUSIONS: A minimally invasive approach for patients undergoing double valve surgery reduces morbidity, mortality, and resource utilization when compared with median sternotomy.


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