Comparison between port-access and less invasive valve surgery

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.