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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Minimally Invasive Aortic Valve Replacement in Elderly Patients: Insights from a Large Cohort
Lukman Amanov1, Arian Arjomandi Rad2, Sadeq Ali-Hasan-Al-Saegh1
1Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
Journal of Clinical Medicine
|January 10, 2026
Summary
Minimally invasive aortic valve replacement (MIAVR) is safe for elderly patients, though they experience higher rates of bleeding and sepsis. Stroke and heart attack rates remain low across all age groups, demonstrating MIAVR
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Interventional Cardiology
Background:
- Transcatheter aortic valve implantation (TAVI) is standard for elderly aortic stenosis patients, but minimally invasive aortic valve replacement (MIAVR) offers surgical durability with less trauma.
- MIAVR is explored as an alternative, particularly for older populations who may not be candidates for TAVI.
- Assessing MIAVR safety and feasibility in elderly patients is crucial for expanding treatment options.
Purpose of the Study:
- To evaluate the safety and feasibility of minimally invasive aortic valve replacement (MIAVR) in elderly patients (≥70 years).
- To compare outcomes between elderly and younger patients undergoing MIAVR.
- To identify specific risks and benefits associated with MIAVR in different age groups.
Main Methods:
- Retrospective cohort study of 990 patients undergoing MIAVR.
- Patients divided into elderly (≥70 years, n=261) and younger (<70 years, n=729) cohorts.
- Analysis included 30-day outcomes and long-term survival data, using multivariable regression and Kaplan-Meier analysis.
Main Results:
- Elderly patients had higher rates of major bleeding (7.7% vs. 4.1%), pacemaker implantation (10% vs. 5.8%), and sepsis (3.4% vs. 1.1%).
- Rates of stroke, myocardial infarction, and postoperative dialysis were comparable between age groups.
- 30-day mortality was higher in the elderly cohort (4.6% vs. 1.6%).
Conclusions:
- Minimally invasive aortic valve replacement (MIAVR) is a feasible and safe surgical option for both elderly and younger patients.
- Increased morbidity in elderly patients undergoing MIAVR is mainly linked to bleeding, pacemaker needs, and sepsis.
- Key adverse events like stroke and myocardial infarction show similar rates across age groups, supporting MIAVR's safety profile.
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