Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients

OBJECTIVES: This study assessed comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients.

METHODS: From January 1, 2000, to December 31, 2008, 1005 patients underwent isolated mitral valve surgery at our institution. Patients ≥ 75-years-old were included in analysis (sternotomy, n = 105; minimally invasive, n = 70). Clinical outcomes included bypass and crossclamp time, length of hospitalization, morbidity, and mortality. To assess resource use, total hospital costs and discharge location were analyzed. Three standardized inpatient functional status outcomes were also assessed.

RESULTS: The minimally invasive approach was associated with a 9.2-minute longer crossclamp time (P = .037) and a 25.2-minute longer bypass time (P < .001). Minimally invasive surgery was associated with a 3.1-day shorter hospitalization (P = .033). There were no significant differences in rate of major postoperative complications (P = .085) or long-term survival (P = .60). Minimally invasive approach was associated with a $6721 lower median cost of hospitalization (P = .007) and more common discharge to home, routinely or with a health aide, rather than to rehabilitation (P = .021). Minimally invasive patients achieved faster rates of independent ambulation (P = .039) and independent sit-to-stand activity (P = .003), although there were no differences in time to independent stair climbing (P = .31).

CONCLUSIONS: Among elderly patients, minimally invasive mitral valve surgery is associated with slightly longer crossclamp and bypass times but with equivalent morbidity and mortality and shorter hospitalization, decreased resource use, and improved postoperative functional status.