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Minimally invasive aortic valve replacement via right mini-thoracotomy for elderly patients with aortic stenosis
Toshinori Totsugawa1, Masahiko Kuinose2, Taichi Sakaguchi1, Arudo Hiraoka1, Kentaro Tamura1, Hidenori Yoshitaka1.
1The Sakakibara Heart Institute of Okayama, Okayama, Japan, 2Kawasaki Medical School, Kurashiki, Japan.

OBJECTIVE: Because of the concerns about increased risk of perioperative complications, minimally invasive aortic valve replacement (MIAVR) for elderly patients with aortic stenosis (AS) remains controversial. Here we reviewed our results of MIAVR in elderly patients with AS.
METHODS: From May 2007 to July 2015, 88 patients with AS underwent MIAVR via right mini-thoracotomy. Seven cases in which concomitant mitral valve surgery and/or arrhythmic surgery were performed via left atriotomy were excluded. Among the 81 patients, 41 patients were more than 75 years old (group E). Perioperative outcome of these patients were compared with those of remaining 40 patients who were less than 75 years old (group Y). Contrast-enhanced CT scan is important in preoperative evaluation of MIAVR especially for elderly patients. If there are any atheromatous plaques in the aorta, we consider additional right axillary cannulation to prevent stroke.
RESULTS: The age of group E was ranged from 75 to 89 years and the ratio of bicuspid aortic valve was significantly higher in group Y (55% versus 12%, p<0.0001). There were no significant differences between two groups in cardiopulmonaory bypass time and aortic cross-clamping time. There were no cases of in-hospital mortality and morbidity including stroke in group E. The ratio of blood transfusion were almost the same (38% versus 44%, p=0.56); only the length of intensive care unit (ICU) stay in group E was longer than that in group Y (1.4±0.7 days versus 1.8±0.7 days, p=0.02).
CONCLUSIONS: Perioperative outcome in group E were almost the same as that in group Y except for ICU stay. Careful preoperative evaluation and appropriate patient selection make MIAVR safe and secure option even in elderly patients.
Our results of minimally invasive aortic valve replacement
Group Y (n=40)Group E (n=41)P value
Age (years)63±1063±10<0.0001
Male: female20:209:320.008
Cardiopulmonary bypass time (min)150±28157±250.25
Aortic cross-clamping time (min)100±19100±120.93
Additional axillary cannulation4 (10%)10 (24%)0.08
In-hospital mortality0.311 (3%)0 (0%)0.31
Stroke1 (3%)0 (0%)0.31
Intensive care unit stay (days)1.4±0.71.8±0.70.02
Hospital stay after surgery (days)15±916±50.46

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