Objectives : Minimal access (MAS) AVR appears to decrease morbidity and resource use when compared to conventional surgery. However, it is unknown whether comparable hemodynamic results are obtained.
Methods : From a total of 225 patients undergoing minimal access AVR trough a partial upper sternotomy, 60 patients were age-, sex- and BSA-matched to 60 patients undergoing conventional AVR operated by a single surgeon during the same implantation period (1999-2002). We compared clinical outcome, pain score (using visual analog score) and postoperative pulmonary function tests on postoperative days 4, 5 and 30. A standardized echocardiogram was obtained before discharge. Only two valve types were used (SJM-Regent and CE-Perimount).
Results :No perioperative death was encountered. No MAS-patient in this series required conversion to full sternotomy. The MAS-group reveals longer aortic cross clamp times and CPB duration, but length of intubation, ICU stay, total blood loss, transfusion need and total hospital stay were all significantly less in the MAS-group. The MAS-patients had less sternal pain at all measured time intervals. Pulmonary function tests were significantly better in the MAS-group at day 4 and 5, but this difference disappeared at day 30. Implanted valve sizes were similar in both groups when corrected for BSA, as shown in Fig. 1. Peak postoperative transvalvular gradients were equal, illustrating the same hemodynamic effectiveness in both groups.
Conclusions : In a case-control study design, minimal access AVR is associated with significantly shorter ICU- and hospital stay, less blood loss and transfusion need and less postoperative pain with better pulmonary function. The hemodynamic results are comparable.
Fig. 1
