Minimally invasive aortic valve replacement - the patient's view

Objectives: Aortic valve replacement (AVR) has been performed through a median sternotomy for many years. Over the last decade various minimally-invasive methods have been developed to improve outcome and patient's satisfaction. This study compares postoperative variables including quality of life (QOL) after conventional and minimally-invasive AVR. Material and Methods: Between 01/1999 and 12/2001 371 patients underwent an conventional (CONV) (n=268) or an upper J-shaped minimally-invasive (n=103) AVR (MIC). In 2002 a postoperative survey including a SF-36 QOL questionnaire was sent to the patients. Follow-up was 100% complete in each group. Patients were equally matched according to age, sex, ventricular function, valvular lesion, and valve prosthesis. Results: No differences between the two groups were recorded for operative time, cardio-pulmonary-bypass-time, cross clamp-time, and minimal core temperature. There were no deaths within 30 days after the operation in the MIC group versus 4.1% in the CONV group (p=0.04). Mortality over the whole study period was 3.9% in the MIC group and 9.3% in the CONV group (p=0.08). Freedom from embolism was 97.8% in CONV group versus 97.1% in MIC group. Freedom from wound healing complications was 97.0% in the CONV group versus 97.1% in the MIC group. There were no statistically significant differences regarding any of the SF-36 QOL categories. Conclusions: Although the minimally-invasive approach is well accepted regarding postoperative cosmetic results for patients requiring AVR, there seem to be no clinically measurable differences in postoperative outcome or QOL.