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Minimally invasive port access surgery reduces operative morbidity for valve replacement in the elderly
E A Grossi1, A C Galloway, G H Ribakove
1Division of Cardiothoracic Surgery, Department of Surgery, New York University Medical School, New York, NY 10016, USA. grossi@cv.med.nyu.edu
Background:
Although minimally invasive techniques for valvular surgery have rapidly come into widespread use, whether such an approach can be safely applied to elderly patients remains an open question. To help resolve this issue, we reviewed our experience with minimally invasive port access (MIPA) valve surgery in elderly patients and compared it to the results obtained with the standard sternotomy (STD) approach in the same age group.
Methods:
From January 1994 through December 1998, 370 consecutive patients at least 70 years of age underwent isolated aortic or mitral valve surgery at our institution. The standard sternotomy operative approach was used in 259 patients (mean age 77.5 years) and the minimally invasive port access approach was used in 111 patients (mean age 76.0; p=.006). A mitral valve procedure was performed more often in the MIPA patients than in the STD patients (49.5% vs. 35.9%; p < .001).
Results:
Hospital mortality was comparable in the two groups, 9.7% (25/259) in the STD group and 7.2% (8/111) in the MIPA group (p = .50), as was the incidence of many perioperative complications. The MIPA group, however, had a significantly lower incidence of sepsis or wound complications (1.8% vs 7.7%; p = .027), required less fresh frozen plasma transfusion (median 1.0 unit vs 2.0 units; p =.04), and had a shorter length of hospital stay (11.6 days vs 17.6 days; p = .001).
Conclusions:
These results indicate that with appropriate surgical techniques the MIPA approach for isolated valve surgery can be safely applied to the elderly patient population with excellent results. In our initial experience the MIPA approach is associated with significantly less plasma transfusion, fewer postoperative complications, and shorter length of hospital stay.
Insights
Minimally invasive port access (MIPA) valve surgery is safe for elderly patients, showing fewer complications and shorter hospital stays compared to standard sternotomy. This approach offers excellent results for isolated valve surgery in this population.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Geriatric Medicine
Background:
- Minimally invasive techniques are increasingly used in valvular surgery.
- Safety and efficacy in elderly patients remain a key question for these techniques.
Purpose of the Study:
- To evaluate the safety and outcomes of minimally invasive port access (MIPA) valve surgery in elderly patients.
- To compare MIPA with the standard sternotomy (STD) approach in patients aged 70 years and older.
Main Methods:
- Retrospective review of 370 patients (≥70 years) undergoing isolated aortic or mitral valve surgery between 1994-1998.
- Comparison of MIPA (111 patients) versus STD (259 patients) approaches.
- Analysis of hospital mortality, perioperative complications, transfusion requirements, and length of hospital stay.
Main Results:
- Hospital mortality was similar between MIPA (7.2%) and STD (9.7%) groups (p=.50).
- MIPA demonstrated significantly lower rates of sepsis/wound complications (1.8% vs 7.7%; p=.027).
- MIPA required less fresh frozen plasma (median 1 unit vs 2 units; p=.04) and resulted in a shorter hospital stay (11.6 vs 17.6 days; p=.001).
Conclusions:
- Minimally invasive port access (MIPA) valve surgery is a safe and effective option for elderly patients undergoing isolated valve procedures.
- The MIPA approach is associated with reduced postoperative complications, less plasma transfusion, and shorter hospital stays compared to standard sternotomy.
- Appropriate surgical techniques enable excellent outcomes with MIPA in the elderly population.