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Do patients want minimally invasive aortic valve replacement?
W Ehrlich1, W Skwara, W Klövekorn
1Division for Thoracic and Cardiovascular Surgery, Kerckhoff-Clinic Foundation, Benekestrasse 2-8, D-61231, Bad Nauheim, Germany.
Summary
Most patients prefer standard sternotomy over minimally invasive aortic valve surgery after objective counseling. Younger patients prioritize cosmetic outcomes, but standard sternotomy offers better surgical exposure and potentially fewer complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Patient-Centered Care
Background:
- Minimally invasive aortic valve surgery offers potential benefits via small incisions.
- Randomized studies have not definitively proven significant advantages of minimally invasive approaches.
- Patient perspectives on surgical approach are crucial for informed decision-making.
Purpose of the Study:
- To assess patient preferences for aortic valve replacement approach after objective counseling.
- To elucidate patient decision-making factors regarding standard versus minimally invasive surgery.
Main Methods:
- Prospective study of 27 patients undergoing isolated aortic valve replacement.
- Objective pre-operative counseling on advantages and disadvantages of both approaches.
- Patients chose between full sternotomy and partial sternotomy after counseling.
Main Results:
- 78% of patients preferred full sternotomy; 22% opted for partial sternotomy.
- Patients choosing partial sternotomy were younger and cited cosmetic reasons.
- Partial sternotomy group showed longer operation times, higher CK/CK-MB levels, and increased ICU stay.
Conclusions:
- Objective patient information leads to a preference for standard sternotomy in most cases.
- Younger patients prioritize aesthetics, but minimally invasive approaches may involve trade-offs in surgical efficiency and outcomes.
- Potential risks like inadequate de-airing may contribute to elevated cardiac enzyme levels in minimally invasive procedures.