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Isolated Minimally Invasive Valve Surgery Outcomes Comparable to Standard Approach
MASOOD A. SHARIFF, Rawan Sharma, Juan A. Abreu, Peter Andrawes, Miriam Sedrak, Mohammed Mustafa, John P. Nabagiez, Joseph T. McGinn, Jr..

OBJECTIVE: Minimally invasive surgery is a sought out approach for isolated valve procedure. In light of evidence that minimally invasive approach add operating room time compared to sternotomy, the overall outcomes are comparable between approaches. This study assessed comparative outcomes between minimally invasive versus traditional sternotomy valve surgery.
METHODS: From January 2005 to November 2012, 402 patients underwent isolated valve surgery at our institution (sternotomy, n=164; minimally invasive, n=238), mitral or aortic. Clinical outcomes included bypass and cross-clamp time, length of hospitalization, morbidity and mortality.
RESULTS: Of the 402 patients, 164 underwent the minimally invasive approach (aortic valve replacement 144 and mitral valve repair or replacement 95) and 164 had a sternotomy (aortic valve replacement 105 and mitral valve repair or replacement 59). The mean age was 67.6±12.8 years for the minimally invasive group and 66.3±11.9 years for the sternotomy group (p=0.298). The minimally invasive approach was associated with a 2.2-minute longer cross-clamp time (89.2±26.3 vs. 87.0±30.3,p=0.433) and, also, a 2.2-minute longer bypass time (121.0±33.8 vs. 118.7±40.4,p=0.547). Surgical time was not significant but comparable (minimally invasive, 246±55 minute vs sternotomy, 253±82 minute, p=0.321). Access to cardiopulmonary bypass was mainly femoral artery and vein cannulation in minimally invasive procedures compared to aorta and atrium in sternotomy. Intraoperative blood product used was significantly less in minimally invasive compared to sternotomy (38% vs. 52%,p=0.004). There were no significant differences in rate of major postoperative complications, except for atrial fibrillation was higher in the minimally invasive group (33% vs. 24%,p=0.045). Minimally invasive surgery was associated with a relatively shorter hospitalization (6.4±3.5 vs. 6.9±4.5,p=0.144).
CONCLUSIONS: Minimally invasive valve surgery was comparable to sternotomy approach with advantages in reduced intraoperative need for blood products and shorter hospitalization. The comparable bypass time and surgical times without overt complications with either approach allows for integration of technique into an established institution with trained surgeons.

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