Minimally Invasive Aortic Valve Surgery in the Elderly: A Case-Control Study

Abstract

Introduction— Although minimally invasive aortic valve surgery (MIAVR) is performed in many centers, few studies have compared its results to a standard sternotomy (SS) approach. We assessed the hypothesis that, when compared with SS in the elderly population, MIAVR has similar morbidity and mortality and allows faster hospital recovery. Methods and Results— From January 1995 through February 2002, 515 patients over age 65 underwent isolated aortic valve replacement. Using data gathered prospectively, 189 MIAVR patients were matched with 189 SS patients by age, ventricular function, valvular pathology, urgency of operation, diabetes, previous cardiac surgery, renal disease, and history of stroke. In each group, 56.1% of patients underwent non-elective procedures, and 28% were ≥80 years old. Hospital mortality (6.9%) and freedom from postoperative morbidity (82.5% versus 81.5%, P =0.79) were similar. Multivariate analysis revealed that urgent procedures [Odds Ratio (OR)=3.97; P =0.03], congestive heart failure (OR=3.94; P =0.03), and ejection fraction <30% (OR=4.16; P =0.03) were significant predictors of hospital mortality. Prolonged length of stay was associated with age ( P =0.05), preoperative stroke (OR=3.5, P =0.001), CHF (OR=2.2, P =0.004), and sternotomy approach (OR=2.3, P =0.002) by multivariate analysis. More MIAVR patients were discharged home (52.6% versus 38.6%, P =0.03) rather than to rehabilitation facilities. Three year actuarial survival revealed no difference between groups. Conclusions— Minimally invasive aortic valve surgery is safe in elderly patients, with morbidity and mortality comparable to sternotomy approach. The shorter hospital stay and greater percentage of patients discharged home after MIAVR reflect enhanced recovery with this technique.