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Eur J Cardiothorac Surg 1999;16:647-652
© 1999 Elsevier Science NL

Minimally-invasive versus conventional aortic valve replacement – perioperative course and mid-term results

^a Klinik und Poliklinik für Thorax-, Herz- und Gefäßchirurgie, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany
^b Klinik und Poliklinik für Kardiologie und Angiologie, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany
^c Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany

Corresponding author. Tel.: +49-251-834-7401; fax: +49-251-834-8316

Objective: We performed a case-control-study to compare perioperative and mid-term results of minimally invasive with conventional aortic valve replacement. Methods: Between 8/96 and 7/97, 113 patients underwent isolated aortic valve replacement (minimally invasive: 29, conventional: 84) in our Department. Diagnosis, ejection fraction, pressure gradient/regurgitation fraction, age, gender and body-mass-index were used as matching criteria for the case-control-study. For qualitative data correspondence was requested, for quantitative data deviations up to 10% were accepted. With these criteria 25 patients of the minimally invasive group were matched to 25 patients of conventional group. All patients were reexplored 1 year after aortic valve replacement. Statistical analysis was done by the Fisher's exact test for qualitative data and the Mann–Whitney test for quantitative data. Results: We implanted 15 (20) bioprosthesis’ and 10 (five) mechanical prosthesis’ in the minimally invasive, respectively, conventional group. There were no statistically significant differences between both groups with respect to the perioperative course, only duration of surgery (mean 201.6 vs. 143.9 min, P<0.01) and extracorporeal circulation (mean 116.1 vs. 71.3 min, P<0.01) as well as aortic-cross-clamp-time (mean 77.9 vs. 46.9 min, P<0.01) were significantly longer in the minimally invasive group. Postoperative complications occurred in one patient of the minimally invasive group (dissection of the right coronary artery) and four patients of the conventional group (third degree AV block, pneumothorax, grand mal convulsion, cardiopulmonary resuscitation). Two patients, one of each group, died during follow-up for unknown reasons. Follow-up revealed no significant differences with respect to clinical and echocardiographic data, but the shorter skin incision was cosmetically more accepted by patients of the minimally invasive group. Minor paravalvular leaks occurred in four patients of the minimally invasive and three patients of the conventional group as diagnosed by transthoracic echocardiography. Conclusions: Both surgical techniques may be performed with comparable perioperative and mid-term results, but the better cosmetic result in the minimally invasive group is paid by a longer duration of surgery.

Key Words: Aortic valve replacement • Minimally invasive surgery • Cardiac surgery • Perioperative course • Mid-term results