Results of minimally invasive aortic valve replacement

Patients with severe aortic valve (AV) stenosis or insufficiency can undergo minimally invasive aortic valve surgery with mini-sternotomy (MS) or full sternotomy (FS).

Our study evaluated 5-year outcomes in patients after minimally invasive surgery for aortic valve replacement (AVR) compared with FS access.

We conducted a single-center registry data analysis of AV patients who underwent only elective, isolated AVR compared to MS, and FS hospitalized between 2014 and 2024 in the Cardiac Surgery Department at the Medical University of Silesia. Redo, emergency, salvage and concomitant procedures were excluded. The 5-year survival data were verified in the National Health Fund. Propensity score matching (PSM) was conducted to determine FS controls for the MS group in a 1 : 1 ratio with a 0.1 SD caliper.

The study group included 1289 elective patients (73 MS, and 1216 FS). All operative and postoperative data before and after PSM are presented in tables. PSM resulted in 65 MS cases and 65 FS controls. The 5-year survival did not differ between groups, either before PSM (HR = 0.92, 95% CI [0.34-2.5]; p = 0.6) or after PSM (HR = 0.79, 95% CI [0.25-2.5]; p = 0.480). After matching, differences were found only in cardiopulmonary bypass time in MS vs. FS (73 [IQR: 61-88] vs. 63 [IQR: 53-77]; p = 0.034) and higher requirement for norepinephrine support (90.8% vs. 61.5%; p < 0.001).

Our study demonstrates that minimally invasive aortic valve replacement offers comparable 5-year outcomes. The results suggest that the less invasive alternative should be the first choice option for patients with aortic valve diseases.