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Outcomes of minimally invasive valve surgery in patients with chronic obstructive pulmonary disease.

OBJECTIVES
We hypothesize that minimally invasive valve surgery in patients with chronic obstructive pulmonary disease (COPD) is superior to the conventional median sternotomy approach.


METHODS
We retrospectively reviewed 2846 consecutive surgery performed at our institution between January 2005 and September 2010, and identified 165 patients with COPD who underwent isolated valve surgery. In-hospital mortality, composite complication rates, intensive care unit and total hospital length of stay of those who had undergone a minimally invasive approach were compared with a cohort that underwent a standard median sternotomy approach.


RESULTS
Of the 165 patients, 100 underwent a minimally invasive approach and 65 had a median sternotomy. Baseline characteristics did not differ between the two groups. The mean age was 71 ± 11 years for the minimally invasive group and 68 ± 12 years for the median sternotomy group, (P = 0.31). In-hospital mortality was 1 (1%) in the minimally invasive group and 3 (5%) in the median sternotomy group, P = 0.14. Composite postoperative complications were significantly reduced in the minimally invasive group (30 versus 54%, P = 0.002). The median intensive care unit length of stay was 47 h (IQR 40-70) versus 73 h (IQR 51-112), P < 0.001, and the median postoperative length of stay was 6 days (IQR 5-9) versus 9 days (IQR 7-13), P < 0.001, for the minimally invasive and the median sternotomy groups, respectively.


CONCLUSIONS
Minimally invasive valve surgery in patients with COPD is associated with excellent short-term results, and thus should be considered an option in these patients.