MINIMALLY INVASIVE CARDIAC-VALVE SURGERY IMPROVES PATIENT SATISFACTION WHILE REDUCING COSTS OF CARDIAC-VALVE REPLACEMENT AND REPAIR

Objective This study compares the quality of valve replacement and rep air performed through minimally invasive incisions as compared to the standard operation for aortic and mitral valve replacement. Summary Ba ckground Data With the advent of minimally invasive laparoscopic appro aches to orthopedic surgery, urology, general surgery, and thoracic su rgery, it now is apparent that standard cardiac valve operations can b e performed through very smalt incisions with similar approaches. Meth ods Eighty-four patients underwent minimally invasive aortic (n = 41) and minimally invasive mitral valve repair and replacement (n = 43) be tween July 1996 and April 1997. Demographics, procedures, operative te chniques, and postoperative morbidity and mortality were calculated, a nd a subset of the first 50 patients was compared to a 50 patient coho rt who underwent the same operation through a conventional median ster notomy. Demographics, postoperative morbidity and mortality, patient s atisfaction, and charges were compared. Results Of the 84 patients, th ere were 2 operative mortalities both in class IV aortic patients from multisystem organ failure. There was no operative mortality in the pa tients undergoing mitral valve replacement or repair. The operations w ere carried out with the same accuracy and attention to detail as with the conventional operation. There was minimal postoperative bleeding, cerebral vascular accidents, or other major morbidity. Groin cannulat ion complications primarily were related to atherosclerotic femoral ar teries. A comparison of the minimally invasive to the conventional gro up, although operative time and ischemia time was higher in minimally invasive group, the requirement for erythrocytes was significantly les s, patient satisfaction was significantly greater, and charges were ap proximately 20% less than those in the conventional group. Conclusions Minimally invasive aortic and mitral valve surgery in patients withou t coronary disease can be done safely and accurately through small inc isions. Patient satisfaction is up, return to normality is higher, and requirement for postrehabilitation services is less. In addition, the charges are approximately 20% less. These results serve as a paradigm for the future in terms of valve surgery in the managed care environm ent.