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Michael A. Borger
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Jan F. Gummert
Friedrich W. Mohr
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Ann Thorac Surg 2002;74:S1318-S1322
© 2002 The Society of Thoracic Surgeons

Supplement: Cardiothoracic Techniques and Technologies

Minimal access aortic valve replacement: effects on morbidity and resource utilization

Nicolas Doll, MDa*, Michael A. Borger, MD, PhDa, Joerg Haina, Jan Bucerius, MDa, Thomas Walther, MD, PhDa, Jan F. Gummert, MD, PhDa, Friedrich W. Mohr, MD, PhDa

a Clinic for Heart Surgery, Heart Center, University of Leipzig, Leipzig, Germany

* Address reprint requests to Dr Doll, Heart Center, Clinic For Cardiac Surgery, University of Leipzig, Strumpellstrasse 39, 04289 Leipzig, Germany.
e-mail: dolln{at}medizin.uni-leipzig.de

Presented at the Eighth Annual Cardiothoracic Techniques and Technologies Meeting 2002, Miami Beach, FL, Jan 23–26, 2002.

BACKGROUND: The aim of this study was to compare outcomes in patients undergoing minimal access versus conventional aortic valve replacement (AVR).

METHODS: We reviewed prospectively gathered data on all patients who were undergoing first-time AVR, with or without replacement of the ascending aorta, over a 1-year period at our institution.

RESULTS: A total of 176 patients underwent minimal access and 258 underwent conventional AVR. The conventional group was older, had more incidence of diabetes, and more aortic stenosis (all p < 0.05). Eight minimal access AVR patients (2%) required conversion to a complete sternotomy. Minimal access AVR patients had longer aortic crossclamp times than conventional AVR patients (60 ± 22 vs 55 ± 23 minutes, p = 0.03) but similar CPB times (93 ± 38 vs 88 ± 42 minutes, p = 0.20). Postoperative creatine kinase–MB levels were similar for the two groups. Total postoperative blood loss was significantly lower in the minimal access group, and these patients received less red blood cell and fresh frozen plasma transfusions. Minimal access AVR patients were less likely to have postoperative respiratory failure (3% vs 10%); they had shorter intensive care unit stays (3.7 ± 5.4 vs 4.5 ± 5.6 days) and shorter hospital stays (10 ± 6 vs 12 ± 7 days, all p < 0.05). Mortality was lower in patients undergoing minimal access surgery (3% vs 9%, p = 0.008) by univariate analysis. Multivariate predictors of mortality were age, hypertension, and CPB time.

CONCLUSIONS: Although patient selection may have influenced some of the observed differences between our patient groups, minimal access surgery appears to be associated with decreased morbidity and resource use when compared to conventional AVR.




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