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Advantages of Minimal Access Versus Conventional Aortic Valve Replacement in Elderly or Severely Obese Patients

Pisano, Calogera MD; Totaro, Pasquale MD, PhD; Triolo, Oreste Fabio MD; Argano, Vincenzo MD

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: March/April 2017 - Volume 12 - Issue 2 - p 102–108
doi: 10.1097/IMI.0000000000000354
Original Articles

Objective The aim of our study was to investigate potential clinical advantages of minimal access versus conventional surgical approach in older and severely obese patients undergoing isolated aortic valve replacement (AVR).

Methods One hundred thirty-five patients undergoing isolated primary AVR were enrolled. Propensity score matching was used to compare 42 selected patients operated on ministernotomy (MS, group B) with 42 selected patients operated on full sternotomy (FS, group A).

Results After propensity score matching, the two groups were comparable in terms of preoperative characteristics. Cardiopulmonary bypass time was significantly longer in MS group compared with the FS group [median (95% confidence level or CL), 103 (98.7–106.4) vs 94 (83.6–99) minutes, respectively; P = 0.0019]. No significant difference was observed in aortic cross-clamp time [median (95% CL), 73 (71.1–78.2) vs 69.5 (62.7–83) minutes; P = 0.4]. Significantly shorter ventilation time [median (95% CL), 13 (12–16.4) vs 24 (22–25) hours; P = 0.00018], intensive care unit stay [median (95% CL), 1 vs 2 days; P = 0.00017], and hospital stay [median (95% CL), 8.5 (8–10.8) vs 13.5 (11.1–14) days; P = 0.00030] were shown in the MS group. The age subgroup analysis showed that statistical significance for mechanical ventilation, intensive care unit, and hospital stay was specific for patients older than 75 years. The analysis of body mass index quartile showed that statistical significance for mechanical ventilation was specific for patients in the fourth quartile.

Conclusions Minimal access AVR is a reproducible, safe, and effective surgical option in patients candidate for isolated AVR, and our study suggests a faster recovery when used in severely obese or older patients.

From the Unit of Cardiac Surgery, Department of Surgery and Oncology, University Hospital “P. Giaccone,” Palermo, Italy.

Accepted for publication February 6, 2017.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Calogera Pisano, MD, Unit of Cardiac Surgery, Department of Surgery and Oncology, University Hospital “P. Giaccone,” Liborio Giuffrè St, N 5 90100 Palermo, Italy. E-mail:

©2017 by the International Society for Minimally Invasive Cardiothoracic Surgery