Outcomes Of Minimally Invasive Cardiac Surgery In High Risk Elderly Patients; Single Centre Experience
Amir Khosravi, Toufan Bahrami, Mahesh Balakrishnan, Fabio De Robertis.
Royal Brompton and Harefield NHS Trust, London, United Kingdom.
Background: Cardiac surgery approached through sternotomy can be associated with significant morbidity and mortality in the elderly population. The aim of this study was to review our experience with minimal access cardiac surgery in patients aged 70 years or older.Materials and Methods: A total of 226 elective patients over the age of 70 years had sternal sparing minimally invasive surgery performed in our centre from January 2011 to October 2018.Results: A total of 226 patients (144 [64%] males and 82 [36%] females), in the age group ranging from 70 to 92 years (mean 79.84 ± 6.52), were included in the study. 54 patients (24%) were above 80 years old. Average EuroSCORE II was 8.9. A total of 94 (41%%) patients underwent bioprosthetic aortic valve replacement 63 (27%) had MIDCAB, 34 (15%) underwent mitral valve repair, 12 (5%) required concomitant tricuspid repair and 12 (5%) including AF ablation. 12 (5%) had isolated AF ablation. There were no conversions to median sternotomy and no 30-day mortalities.Conclusion: Minimally invasive cardiac surgery is safe and feasible with excellent outcomes in the elderly. In our practice, it is the treatment of choice for elective first time cardiac surgery in elderly patients over the age of 70 years. Despite high logistic EuroSCOREs, we have shown excellent results in octogenarians by this approach. In this era of transcatheter aortic valve implantation, mini-AVR needs to be in the armamentarium of the surgical team.
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