Advantages of minimal access versus conventional aortic valve replacement in elderly or severely obese patients.

Objective: the aim of the study to evaluate the benefits of minimal access versus conventional surgery in elderly obese patients undergoing aortic valve replacement (AVR). Materials and Methods: this is a retrospective, observational, cohort study of prospectively collected data on 45 elderly and obese patients undergoing isolated primary AVR between July 2012 and March 2014 in our Cardiac Surgery Unit. Of these, 31 were performed with conventional surgery and 14 were performed with an upper ministernotomy. With propensity score matching, 14 patients (minimally invasive group) were compared with 14 patients in conventional sternotomy (control group). Results: After propensity matching score the two groups were comparable in terms of preoperative characteristics. Median age was 76±7 years in minimally invasive group and 76.7± 10 years in control group, the BMI was respectively 32.2 ± 6.8 and 30.5± 5.6. Cardiopulmonary bypass time was longer in minimally invasive group than in control group (107.7± 22.9 vs 92.4± 19.1 min, p= 0.065) , no significant difference in aortic cross clamp time (76.9± 19.4 vs 72± 16.5 min, p= 0.48) but shorter ventilation time (13±8 vs 23± 13 hours, p=0.029), intensive care unit stay (1±1 vs 2±2 days, p=0.026) and hospital stay (8.5± 4 vs 13.5± 7 days, p=0.037). No difference in the incidence of major and minor postoperative complications and related morbidity was observed. Conclusions: Our limited experience shows that mini-access isolated AVR is a reproducible, safe and effective surgical option in elderly obese patients. Because shorter ventilation time and faster recovery we therefore advocate minimal approach as the procedure of choice for primary isolated AVR in these cohort of patients.