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Is there an Impact on Postoperative Morbidity and Long Term Survival after Minimal Invasive Access? A Single Centre Study of 7290 Patients with aortic valve replacement.
Sven Lehmann, Fabian Emrich, Christian D. Etz, Martin Misfeld, Anna Meyer, Anne K. Funkat, Jens Garbade, Friedrich W. Mohr.
Heartcenter Leipzig, Leipzig, Germany.

OBJECTIVE: Minimally invasive techniques are progressively challenging traditional approaches in cardiothoracic surgery. The aim of this study was to compare outcomes in patients undergoing minimal (MIS) versus conventional (CON) access aortic valve replacement.
METHODS: 7290 consecutive patients undergoing primary aortic valve replacement at our institution from 11/94 to 06/15 were reviewed: 1776 patients had a MIS access and 5515 a CON access.
RESULTS: Patients in the CON group were significantly older than MIS patients (67±11 vs. 66±13 years, p<0.01), had a lower EF (57±15 vs. 60±12%, p<0.01) and a higher logEuroscore (8.3±10 vs. 5.5±5.5, p<0.01). There is no difference in cross-clamp time (50±23 vs. 52±23 min, p=0.15) between two groups. 30-day survival rate was 98.2±0.3 (MIS) and 94.4±0.3 (CON; p<0.01). The Survival rate after 15 years was 70.9±1.8% (MIS) vs. 53.1±1.0% (CON; p<0.01). The multivariate analysis revealed COPD (p<0.01, OR=2.2), age over 70 years (p<0.01, OR 1.8), pre-operative i.v. inotropic (p<0.01, OR 6.5), dialysis (p<0.01, OR 3.7), emergency operation (p<0.01, OR 4.5), preoperative reanimation (p=0.02, OR 3.2), preoperative cardiac shock (p<0.01, OR 4.1), prior cardiac surgery (p<0.01, OR 2.3), active endorcarditis (p<0.01, OR 2.1) and female gender (p=0.01, OR=1.5) as independent risk factors for 30 day mortality.
CONCLUSIONS: Although patient selection may have influenced some of the observed differences between our patient groups, minimal access surgery appears to be associated with significantly lower postoperative morbidity and superior long term survival.

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