Minimally invasive aortic valve surgery in the elderly: a case-control study.

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Minimally Invasive Techniques

Background:

• Minimally invasive aortic valve surgery (MIAVR) adoption is widespread, yet comparative outcome data against standard sternotomy (SS) are limited.
• Elderly patients undergoing aortic valve replacement present unique challenges and benefits for surgical approaches.

Purpose of the Study:

• To compare the morbidity, mortality, and recovery profiles of MIAVR versus SS in patients aged 65 and older.
• To evaluate the hypothesis that MIAVR offers comparable safety and faster hospital recovery in the elderly population.

Main Methods:

• Prospective data from 515 elderly patients (>65 years) undergoing isolated aortic valve replacement were analyzed.
• 189 MIAVR patients were propensity-matched with 189 SS patients based on key clinical and demographic factors.
• Outcomes including hospital mortality, postoperative morbidity, length of stay, and discharge destination were compared.

Main Results:

• Hospital mortality (6.9%) and postoperative morbidity were similar between MIAVR and SS groups (82.5% vs. 81.5%, P=0.79).
• MIAVR patients had a significantly higher rate of discharge directly home (52.6% vs. 38.6%, P=0.03), indicating faster recovery.
• Urgent procedures, congestive heart failure, and low ejection fraction were predictors of hospital mortality; age, stroke, CHF, and sternotomy approach predicted prolonged hospital stay.

Conclusions:

• MIAVR is a safe and effective alternative to SS for elderly patients undergoing aortic valve replacement.
• The MIAVR approach facilitates enhanced recovery, evidenced by shorter hospital stays and a greater proportion of patients returning home.
• These findings support MIAVR as a beneficial surgical option for older adults requiring aortic valve surgery.