Routine minimally invasive aortic valve procedures

Background: Due to the lack of objective evidence supporting the advantages and early technical difficulties, minimally invasive aortic valve procedur es were performed on a highly selective rather than routine basis. Methods: From September 1997 to February 1999, one surgeon routinely used u pper or transverse minimally invasive sternotomy to perform 46 consecutive cases of aortic valve procedures (M), whereas two other surgeons performed 40 aortic valve procedures through a conventional sternotomy (C). Results: More time consuming and technically demanding surgeries were done in M, There was one death in each group, Aortic clamp time was longer in M (93 +/- 40 vs 59 +/- 24 min, P = 0.001), There were no differences in opera ting time, pump time, intubation duration. bleeding and intensive care unit stay. The advantages of minimally invasive aortic valve operation included better postoperative ejection fraction (58 +/- 17 vs 51 +/- 10%, P = 0.04) , decreased pain score (3 +/- 2 vs 5 +/- 2, P = 0.004), less transfusion (1 9 vs 55%, P= 0.02). shorter duration of chest tube drainage, and cosmetical ly more acceptable surgical wound (6.8 +/- 2.2 vs 5.2 +/- 2.0, P = 0.018). From our series, we could not find any negative effects of minimal access s urgery. Conclusions: Our study demonstrated that aortic valve surgeries could be pe rformed routinely by the minimally invasive approach with a high degree of effectiveness and safety. (C) 2000 The International Society for Cardiovasc ular Surgery. Published by Elsevier Science Ltd. All rights reserved.