Minimally invasive versus conventional aortic valve operations: A prospective study in 120 patients

Background. Risk evaluation comparing the minimally invasive and standard a ortic valve operations has not been studied. Methods. Four surgeons were randomly assigned to perform the minimally inva sive (L-shaped sternotomy) (group 1) or the conventional (group 2) operatio n in 120 patients exclusively. Results. In both groups (n = 60) a CarboMedics prothesis was implanted in 9 0% of patients. There was no significant difference in the cross-clamping p eriod (group 1, 60 minutes; range, 35 to 116 minutes), in the duration of e xtracorporal circulation (group 1, 84 minutes; range, 51 to 179 minutes) or in the time from skin-to-skin (group 1, 195 minutes; range, 145 to 466 min utes). Patients in group 1 were extubated earlier (p < 0.001), the postoper ative blood loss was less (p < 0.001), and the need for analgesics was redu ced (p < 0.05). In 5 patients in group 1 a redo operation was required for bleeding (p > 0.05), 3 patients in group 1 required a redo operation becaus e of paravalvular leakage or endocarditis (p > 0.05), the 30-day mortality rate was 1.6%. Overall the survival rate was 95% in group 1 and 97% in grou p 2 (mean follow-up, 294 days; range, 30 to 745 days). Conclusion. The advantages of minimally invasive aortic valve operation inc lude reduced trauma from incision and duration of ventilation, decreased bl ood loss and postoperative pain, the avoidance of groin cannulation, and a cosmetically attractive result. Simple equipment is used with a high degree of effectiveness and with no sacrifice of safety. Our study demonstrated t he practicability and reliability of this new method. (Ann Thorac Surg 1999 ;67:1001-5) (C) 1999 by The Society of Thoracic Surgeons.