Prospective comparison of minimally invasive and standard techniques for aortic valve replacement: initial experience in the first hundred patients.

Background: Aortic valve replacement (AVR) can be performed through a partial upper sternotomy. In this study we compared the early postoperative outcome in two groups of patients who underwent AVR with a minimally invasive procedure (n = 30) or with a conventional approach (n = 70). The predicted operative mortality (Parsonnet Index) was slightly higher in the conventional group (17.69 +/- 0.85 versus 12.7 +/- 1.02), reflecting the greater mean age of the patients (70.96 +/- 1.17 versus 64.20 +/- 2.57).

Results: The distribution of the different etiologies of aortic valve pathology did not differ between groups. There was no postoperative death in the mini-invasive group. Cardiopulmonary bypass time was longer in the mini-invasive group, but the other operative parameters did not differ between groups. Postoperative morbidity regarding the need for blood transfusion, the duration of assisted ventilation, length of stay in the intensive care unit, and abnormalities of cardiac rhythm and conduction was slightly but not significantly reduced in the mini-invasive group.

Conclusions: Our data demonstrate that a partial upper sternotomy is a safe and effective technique for AVR. Postoperative morbidity is not significantly reduced in patients undergoing AVR by this approach. Further studies in a larger patient population are necessary to assess whether postoperative morbidity is significantly reduced.