Minimally invasive aortic valve surgery: technical considerations and results with the parasternal approach.

BACKGROUND: The history of surgery over the last 30 years has moved steadily toward minimally invasive surgery; more recent experience with the gall bladder, arthroscopy, and video-assisted thoracic surgery has confirmed this trend.
METHODS: Our experience in minimally invasive valve surgery between July 1996 and October 1997 included 180 patients, 80 with aortic valve replacement and 100 with mitral valve replacement. The 80 aortic valve replacement patients consisted of 46 males and 34 females, with a mean age of 63 years (range 32 to 90 years) and mean New York Heart Association Functional Class 2.5. The etiology of disease was varied: degenerative in 41 patients, congenital in 17, rheumatic in 8, subacute bacterial endocarditis in 6, myxomatous in 4, and structural valve degeneration in 4.
RESULTS: There were two (2.5%) operative deaths, both from multisystem organ failure. Only 16 (20%) of the 80 patients experienced new postoperative atrial fibrillation. The mean length of stay in the hospital was 5 days (range 3 to 24 days). Only 18 (23%) of the 78 surviving patients required posthospital rehabilitation, and there were no late deaths. Morbidity included cerebrovascular accident in 1 patient (1.2%), sternal infection in 1 (1.2%), groin infection in 1 (1.2%), and bleeding requiring reoperation in 1 (1.2%).
CONCLUSIONS: Minimally invasive cardiac valve surgery is extremely effective and has become our current technique of choice in every mitral and aortic valve patient who does not have coronary artery disease because it reduces the length of hospital stay and cost, requires fewer blood transfusions, and stimulates less atrial fibrillation.