Minimally invasive versus standard approach aortic valve replacement: A study in 506 patients

Background. Minimally invasive aortic valve replacement through partial upper sternotomy has been shown to reduce surgical trauma, and, supposedly, decrease postoperative pain, blood loss, and hospital stay. Methods. From October 1997 until November 2004, 506 patients received isolated aortic valve replacement, of which 232 underwent the minimal access J- sternotomy approach ( group 1). The control group ( group 2) consisted of 274 patients who underwent aortic valve replacements by median sternotomy. We retrospectively reviewed outcomes of the patients in the early follow- up period. Results. In group 1 and group 2, respectively, early mortality was 2.6% ( 6 patients) and 4.4% ( 12 patients). The minimal access group had reduced aortic cross-clamp and cardiopulmonary bypass times compared with conventional group: 61.8 +/- 16.6 versus 69.5 +/- 16.6 minutes ( p < 0.05) and 88.8 +/- 23.2 versus 100.2 +/- 22.6 minutes ( p < 0.05), respectively. Mean blood loss was lower in group 1 compared with group 2 ( p < 0.05). Intensive care unit and hospital stays were shorter in the minimal access group: 2.1 +/- 2.5 versus 2.5 +/- 5.3 days ( p = nonsignificant) and 10.8 +/- 7.1 versus 12.8 +/- 10.6 days ( p < 0.05), respectively. Conclusions. Aortic valve replacement can be performed safely through a partial upper sternotomy on a routine basis for isolated aortic valve disease.