Related Experiment Video
Updated: Aug 20, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Propensity score analysis of a six-year experience with minimally invasive isolated aortic valve replacement
Ram Sharony1, Eugene A Grossi, Paul C Saunders
1Division of Cardiothoracic Surgery, Department of Surgery, New York University School of Medicine, New York, USA.
Background And Aim Of The Study:
Although minimally invasive aortic valve replacement (MIAVR) is becoming an accepted technique, additional outcome evaluation is required. To correct for non-randomized treatment, the propensity score was used to analyze the present authors' experience with MIAVR compared to standard sternotomy (SS).
Methods:
Between January 1995 and December 2002, a total of 921 consecutive patients underwent isolated AVR; 438 of these patients had MIAVR. Two matched cohorts each of 233 patients, and with comparable distributions of risk factors, were constructed using propensity analysis of prospectively collected data. Matching variables included left ventricular ejection fraction <30%, previous myocardial infarction, congestive heart failure, previous cardiac surgery, renal insufficiency, age, gender, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, previous stroke or carotid disease, urgent/emergent operation, valvular pathophysiology, and atheromatous aortic disease.
Results:
Hospital mortality and major morbidity were similar in the MIAVR and SS groups: 5.6% versus 7.3% (p = 0.45) and 13.3% versus 14.2% (p = 0.79), respectively. Multivariable analysis of all patients revealed increased mortality with severe atheromatous aortic disease (p = 0.001), COPD (p = 0.002), and urgent operation (p = 0.02). Freedom from any major perioperative morbidity was similar in both groups (86.7% versus 85.8%; p = 0.79). However, the median length of stay was shorter with MIAVR (6 versus 8 days; p <0.001). During the past three years, a greater percentage of MIAVR patients than SS patients was discharged home rather than sent to rehabilitation facilities or nursing homes (65.7% versus 52.9%; p = 0.05).
Conclusion:
MIAVR can be performed safely, with morbidity and mortality outcomes similar to those of standard sternotomy. MIAVR is associated with a decreased length of hospital stay, and a greater proportion of patients are discharged home directly.
Insights
Minimally invasive aortic valve replacement (MIAVR) offers similar safety and effectiveness to standard sternotomy (SS) for aortic valve replacement. MIAVR leads to shorter hospital stays and more direct home discharges, improving patient recovery outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Aortic Valve Replacement
Background:
- Minimally invasive aortic valve replacement (MIAVR) is an emerging technique requiring further outcome validation.
- Non-randomized treatment comparisons necessitate advanced statistical methods like propensity score matching.
- Evaluating MIAVR against standard sternotomy (SS) is crucial for establishing its clinical utility.
Purpose of the Study:
- To compare the outcomes of MIAVR versus standard sternotomy (SS) for isolated aortic valve replacement (AVR).
- To utilize propensity score analysis to mitigate bias in a non-randomized study design.
- To assess hospital mortality, major morbidity, length of stay, and discharge destination.
Main Methods:
- Propensity score matching was used to create two comparable cohorts of 233 patients each from a total of 921 isolated AVR patients.
- Matching criteria included numerous risk factors such as ejection fraction, comorbidities, and urgency of operation.
- Data were collected prospectively between January 1995 and December 2002.
Main Results:
- Hospital mortality (5.6% vs 7.3%) and major morbidity (13.3% vs 14.2%) were statistically similar between MIAVR and SS groups.
- Multivariable analysis identified severe atheromatous aortic disease, COPD, and urgent operation as predictors of increased mortality.
- MIAVR demonstrated a significantly shorter median length of hospital stay (6 vs 8 days) and a higher rate of direct home discharge (65.7% vs 52.9%).
Conclusions:
- MIAVR is a safe and effective alternative to SS for aortic valve replacement, with comparable mortality and morbidity.
- The MIAVR approach is associated with significant benefits, including reduced hospital length of stay.
- Patients undergoing MIAVR have a greater likelihood of being discharged directly home, indicating improved recovery and potentially reduced need for transitional care.
