Midterm results and quality of life after minimally invasive vs. conventional aortic valve replacement

BACKGROUND: This study compares early and mid-term results as well as the quality of life (QOL) between the minimally invasive and conventional aortic valve replacement (AVR).

METHODS: Between 7/97 and 4/01, 70 patients (mean age 64.3 +/- 1.3 years) underwent minimally invasive AVR (group M) through an L-shaped ministernotomy. The results were compared to those of 70 conventional AVR (group C) patients during the same period. Patients were equally matched according to age, sex, ejection fraction, valvular lesion, and valve prosthesis. In groups M and C, follow-up was 98.5 % and 95.4 % complete and averaged 34.0 +/- 10.3 and 33.1 +/- 12.9 months, respectively.

RESULTS: There were no hospital deaths in group M but two deaths in group C (p = n. s.). Conversion to full sternotomy was necessary in two group M patients. Cross-clamping time (71 +/- 15 min vs. 58 +/- 18 min), cardiopulmonary bypass time (105 +/- 22 min vs. 84 +/- 24 min), and time of surgery (228 +/- 45 min vs. 184 +/- 48 min) were significantly longer in group M. No statistically significant differences between the two groups for postoperative ventilation time, transfusion rate, ICU stay or length of hospital stay were recorded. At the end of follow-up, 98.5 % vs. 96.9 % of the patients were free of thromboembolism (p = n. s.), 100.0 % vs. 96.9 % were free of endocarditis (p = n. s.), and 98.5 % vs. 100.0 % were free of reoperation (p = n. s.) in group M compared to group C. Survival was 97.0 % vs. 91.9 % (p = ns). No differences in any of the 8 QOL categories, in patient satisfaction with the operative result or in judgment of the cosmetic aspect were noted among groups.

CONCLUSIONS: This study has failed to show any advantage of minimally invasive AVR in early or midterm follow-up.