Background. Valvular operations have followed coronary artery bypass grafti
ng as procedures that are amenable to a minimally invasive approach. This s
tudy is a review of our brief experiences of less invasive valve surgery (L
IVS) through a partial sternotomy approach and port-access valve surgery (P
AVS) with an attempt to compare safety and cost-effectiveness of the surgic
al procedure and post-discharge follow-up.
Methods. Forty PAVS and 66 LIVS procedures performed between May 1996 and D
ecember 1998 were reviewed. The PAVS patients were younger, included more m
en, and had greater left ventricular function. Aside from these particular
data points, there was no significant difference in preoperative variables
between groups.
Results. Operating room time, surgery time, and cross-clamp time were signi
ficantly longer in the PAVS group. The operative mortality was 3% (LIVS) an
d 5% (PAVS). There was more new atrial fibrillation in LIVS (26% versus 5%,
p = 0.009). Postoperative follow-up revealed 77% of LIVS and 76% of PAVS p
atients had returned to work and more than 95% of the retired patients in b
oth groups had resumed their daily activities. Importantly, PAVS patients r
eturned to work about 4 weeks sooner than LIVS patients did.
Conclusions. Early clinical outcomes are comparable between the two approac
hes, which indicates safety and importance of appropriate patient selection
. More follow-up is required to assess postoperative pain and cosmetic sati
sfaction. At the present time, LIVS appears to be more cost-effective. Earl
y return to work in the PAVS group may be the most important finding to fur
ther support the port-access approach. However, with practice pattern chang
es and increased intraoperative efficiencies, each of these two surgical te
chniques may continue to have an important role in the minimally invasive v
alve surgery arena. (C) 1999 by The Society of Thoracic Surgeons.