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OBJECTIVE: Minimally invasive surgery for isolated valve lesions in elderly patients yields a lower morbidity and mortality when compared with median sternotomy and should be considered when such individuals require valve surgery. This approach give smaller operative wound and operative trauma, faster recovery and lower risk of sternal instability with better cosmetic efect
METHODS: We compared 300 patients after aortic valve replacement operated with mini and 300 patients with full sternotomy approach. The patients received mechanical, biological stented, stentless and sutureless valves in the same proportion.
RESULTS: The time of CCU stay, mechanical ventilation, value of bleeding , tamponade and blood transfusion, using of inotropes or IABP, rythm disorders, neurological complications and hospital mortality was analyzed. The significant difference (p<0,05) between mini and full sternotomy was observed only in number of bleeding patients 3 vs 6%, and necessity of blood transfusion (1,7 vs 3,5 units), without difference in mechanical ventilation time, CCU stay, ECC and cross clamp time (100,9 vs 98,2min and 66,7 vs 64,5min)
In miniinvasive group there were no full sternotomy conversions 11 pts were reoperated due to suspicion of tamponade and 7 pts due to increased bleeding, 93 pts required low dose of inotropic support and 5 pts died durring in-hospital stay.
CONCLUSIONS: A minimally invasive aortic valve replacement through upper ministernotomy is safe and feasible. Does not shorten hospital stay but it significantly reduces ventilation time and postoperative inotropic support. There is no significant difference in extracorporeal circulation and aortic cross clamp time between two compared groups.Offers excellent cosmetic results.Minimally invasive aortic valve replacement should be used as a standard approach to isolated aortic valve disease, also in risky patients.