Port-access aortic valve surgery: a technique in evolution

Abstract

Background: Innovative minimally invasive surgical techniques have been developed for treating many cardiac diseases. We reviewed our experience with port-access aortic valve replacement (PAVR) surgery.

Methods: We retrospectively reviewed the charts of patients with aortic valve disease who underwent surgical correction using the Heartport System and minithoracotomy (PAVR) from January 1998 to December 2002 (n = 58) and matched them 1:1 with a cohort of patients who underwent AVR with conventional sternotomy.

Results: No preoperative statistical differences existed between the groups, including age, sex, New York Heart Association class, and ejection fraction. Perioperatively, there was a statistically significant difference between the AVR and PAVR groups with regard to aortic cross-clamp time (74.0 +/- 22.9 minutes versus 92.7 +/- 20.4 minutes, P < .01). Average operative times improved in the PAVR group by almost 83 minutes from the first 10 patients to patients 21 to 31 (P = .05). PAVR patients also averaged shorter stays in the intensive care unit (ICU) (1.5 days less) and hospital (1.8 days less) and were extubated sooner (4.9 hours). Mortality (1/58, 1.7%) and morbidity (reoperation for bleeding, infection, and stroke) were similar for both groups.

Conclusions: This minimally invasive approach to aortic valve surgery allows patients to be extubated earlier and promotes shorter stays in the ICU and hospital. These data suggest that the PA approach is an attractive alternative for patients requiring aortic valve surgery. There also appears to be a rapid surgeon learning curve.