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

Ram Sharony1, Eugene A Grossi, Paul C Saunders

  • 1Division of Cardiothoracic Surgery, New York University School of Medicine, New York, NY, USA.

Circulation
|September 13, 2003
PubMed
Abstract

Insights

Minimally invasive aortic valve surgery (MIAVR) in elderly patients shows similar safety and outcomes to standard sternotomy (SS). MIAVR offers enhanced recovery, with shorter hospital stays and more patients discharged home.

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.

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