Minimally Invasive Valvular Surgery in the Elderly　― Safety, Early Recovery, and Long-Term Outcomes ―

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  • Hisatomi Kazuki
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Miura Takashi
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Obase Kikuko
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Matsumaru Ichiro
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Nakaji Shun
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Tanigawa Akihiko
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Taguchi Shunsuke
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Takura Masayuki
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Nakao Yuko
    Department of Cardiovascular Surgery, Nagasaki University Hospital
  • Eishi Kiyoyuki
    Department of Cardiovascular Surgery, Nagasaki University Hospital

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Abstract

<p>Background: For elderly people, the benefit of minimally invasive cardiac surgery (MICS) is unclear, so we evaluated the safety, recovery, and long-term survival in elderly MICS patients.</p><p>Methods and Results: 63 propensity score-matched pairs of 213 consecutive patients (≥70 years old) who underwent mitral and/or tricuspid valve surgery between 2010 and 2020 (121 right mini-thoracotomies vs. 92 full sternotomies) were compared. The primary outcome was safety (composite endpoint of in-hospital death or major complication). Secondary outcomes were early ambulation and discharge to home. There were no differences between the groups for in-hospital death (3.2% vs. 0.0%, P=0.157) and primary outcome (14.3% vs. 17.5%, P=0.617). The rate of early ambulation (73.0% vs. 55.6%, P=0.048) and discharge to home (66.7% vs. 49.2%, P=0.034) were significantly higher in the mini-thoracotomy group. Major complication was an independent negative predictor of early ambulation for mini-thoracotomy but not for a conservative approach. Survival was 87.8±4.4% vs. 86.8±4.7% at 5 years, which was not significantly different.</p><p>Conclusions: Similar safety but better recovery were observed for mini-thoracotomy, and long-term survival was comparable between groups. Major complication was a negative predictor of early ambulation after mini-thoracotomy. Careful preoperative risk stratification would enhance the benefits of MICS in elderly patients.</p>

Journal

  • Circulation Journal

    Circulation Journal 86 (11), 1725-1732, 2022-10-25

    The Japanese Circulation Society

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