Less invasive versus conventional heart valve surgery in patients with severe heart failure

Abstract

Patients with severe heart failure might benefit from reduced operative trauma, but rarely undergo less-invasive valve surgery. The present study compared the outcomes of less-invasive heart valve surgery with those of complete sternotomy in such patients. From January 1995 to July 2010, 871 patients in New York Heart Association class III or IV underwent valve surgery (aortic or mitral, or both). A less-invasive approach was used in 205. Propensity score matching yielded 185 matched pairs for outcomes comparison adjusted for patient characteristics and 139 pairs adjusted further for individual surgeon. Without considering surgeons, myocardial ischemic times (59 ± 27 vs 64 ± 26 minutes, P=.04), cardiopulmonary bypass times (75 ± 35 vs 86 ± 34 minutes, P<.0001), and intensive care unit stays (median, 24 vs 43 hours; P=.007) were shorter for less-invasive surgery. Hospital morbidity, mortality (1.6% [3 of 185] vs 2.7% [5 of 185]; P=.5), and long-term survival (53% and 48% at 12 years; P=.3) were similar. After considering the surgeon, these benefits were not apparent; rather, efficiency, safety,and effectiveness were equivalent to those of complete sternotomy. Thus, myocardial ischemic (63±30 vs 62 ± 25 minutes, P=.8) and cardiopulmonary bypass (80 ± 40 vs 81 ± 31 minutes, P=.5) times were similar, as were intensive care unit stay (median, 28 vs 30 hours; P=.09), postoperative complications, in-hospital mortality (2.2% [3 of 139] vs 3.6% [5 of 139]; P=.5), and long-term survival (57% and 53% at 12 years; P=.5). In selected patients with severe heart failure, less-invasive valve surgery is a viable option, yielding at least equivalent efficiency, safety, and effectiveness to complete sternotomy. However, achieving these outcomes requires surgeons experienced in less-invasive surgery.