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Minimally invasive versus conventional aortic valve replacement: a 10-year experience.

AIM
Data on the impact of minimally invasive approach on clinical outcomes after isolated aortic valve replacement (MIAVR) are limited and somewhat controversial. The aim of the study was to compare the outcomes of patients undergoing MIAVR and conventional aortic valve replacement (CAVR) in a large cohort of patients operated over a decade.


METHODS
The study population consisted of 466 consecutive patients undergoing isolated AVR between 1995 and 2005. Outcomes of 164 patients undergoing MIAVR were compared to 302 patients undergoing CAVR. Univariable and multivariable analyses were performed to identify predictors of outcomes.


RESULTS
Operative mortality and major complication rates were similar among the groups. Univariate analysis revealed that MIAVR was associated with reduced incidence of allogeneic blood transfusions (31% vs. 41%, P=0.03) and a shorter hospital stay (5+/-2 vs. 7+/-5 days, P<0.0001). In multivariable analysis, predictors for blood transfusions were age (OR=2.15), non elective operation (OR=1.36), female gender (OR=1.13), prolonged cardiopulmonary bypass time (OR=1.12) and CAVR (OR=2.57). Predictors of prolonged hospital stay were peripheral vascular disease (OR=4.83), diabetes mellitus (OR=3.2), aortic cross clamp time (OR=1.17), and CAVR (OR=4.46).


CONCLUSION
MIAVR is a safe and effective procedure resulting in significant reduction of allogeneic blood transfusions and a shorter length of hospital stay.