Minimally invasive aortic valve replacement: Echocardiographic and clinical results

Background Port access has been described for mitral and bypass surgery. Th e purpose of this study was to review the clinical and echocardiographic ou tcomes of aortic valve replacement by use of port access. Methods Between 1996 and 1999, 153 port-access aortic valve replacements we re performed at our institution. The mean age was 63 years (range 16-91 yea rs); 58% were male. The New York Heart Association mean class was III; 18% were in class IV. Thirteen percent had diabetes, 42% hypertension, 7% prior transient ischemic episode or stroke, 7% lung disease, 3% renal failure, a nd 13% previous surgery. Echocardiograms were obtained after valve replacem ent in 125 patients (96 intraoperative transesophageal and 97 transthoracic echoes). Results Median length of stay was 8 days. There were no intraoperative deat hs; 10 patients (6.5%) died in the postoperative period. Stroke occurred in 4 (2.6%), sepsis in 5 (3.3%), renal failure in 5 (3.3%), pneumonia in 3 (2 %), and wound infection in 1 (0.7%). Tissue prosthesis was present in 83 an d a mechanical prosthesis in 42. No or trace regurgitation was seen on 94 o f 96 (98%) postbypass intraoperative echocardiograms and mild on 2. On foll ow-up echocardiograms, moderate regurgitation was seen in 4 of 97 (4.1%), m ild-to-moderate in 2 (2.1%), mild in 18 (18.6%), and no or trace in 71 (73. 2%). Of those who had aortic regurgitation on intraoperative or follow-up e chocardiograms, it was paravalvular in 8. Conclusions Minimally invasive aortic valve replacement with a port-access approach is feasible, even in high-risk patients. Small incisions, a low in fection rate, and a short length of stay are attainable. However, the compl ications associated with traditional aortic valve replacement still occur. Echocardiography is valuable both for intraoperative monitoring and follow- up of this new procedure.