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A 16 Year Experience in Minimally Invasive Aortic Valve Replacement: Context for the Changing Management of Aortic Valve Disease
Igor Gosev, Tsuyoshi Kaneko, Siobhan McGurk, Scott R. McClure, Ann Maloney, Lawrence H. Cohn.
Brigham and Women's Hospital, Boston, MA, USA.

OBJECTIVE: Aim of this study was to evaluate short and long term morbidity and mortality in patients with aortic valve disease that had minimally invasive aortic valve replacement through upper hemisternotomy
METHODS: From July 1996 to June 2012, 1639 patients underwent minimally invasive aortic valve surgery. Patient data was extracted from hospital electronic records after IRB approval. Outcomes of interest included postoperative complications and survival with separate evaluation of patients that underwent reoperations and patients over 80 years of age.
RESULTS: The average age was 67.03 years (Range 22-95 years). There were 363 (22.2%) octogenarians and 211 (12.9%) of the patients underwent reoperative procedures.
Postoperatively, 2.3 % (37/1639) had reoperations to correct bleeding, 2.7% (44/1639) had strokes 20.4% (334/1639) had new onset atrial fibrillation and 1.5% (24/1639) required permanent pacemakers. Only 34% (571/1639) of patients received packed red cells. The median discharge was on day 6 (5-8), and 72.2% of patients (1184/1639), were discharged home. Overall unadjusted operative mortality was 2.9% (48/1639). Operative mortality for the octogenarian group was 5.2% (19/363) and 5.7 % (12/208) for reoperative patients. Long term survival overall at 1yr was 94(+/-1)%, 83% (+/-1) at 5yrs, and 66% (+/-3) 10yrs postoperatively. For reoperative patients, 1 yr survival was estimated to be 89% (+/-4), 70% (+/-6) at 5yrs, and 41%(+/-9) at 10yrs. Long term survival in octogenarians was 87% (+/-4) at 1yr, 64%(+/-6) at 5yrs, and 48% (+/-7) at 7yrs.
CONCLUSIONS: The upper hemisternotomy approach for aortic valve replacement is safe and reliable. Patients older then 80 years and patients undergoing reoperations benefit the most with decreased mortality and morbidity. These data provide a benchmark against which outcomes of percutaneous/transapical aortic valve replacements should be compared


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