Minimal invasive valve surgery provides better outcomes in older patients: Mount Sinai study

The Annals of Thoracic Surgery has just published a study conducted at Mount Sinai Medical Center of Miami Beach reporting the outcomes of minimally invasive valve surgery versus traditional median sternotomy in patients 75 years of age or older. Minimally invasive valve surgery at Mount Sinai is performed through a small, 2-inch incision on the right side of the chest, and this was compared with the same kind of valve surgery done through a breastbone splitting approach.  The investigators hypothesized that in elderly patients, a smaller, less traumatic surgery would lead to better results.  Minimally invasive valve surgery in elderly patients increased survival, reduced postoperative complications, and shortened length of hospital stay when compared with traditional median sternotomy surgery.

One out of every eight individuals over the age of 75 has moderate to severe valvular disease. This is a potential population of 4.2 to 5.6 million at present. This number is expected to double by 2030, as our population ages. Many elderly patients, however, are denied intervention by surgical centers and excluded from studies due to old age. Mount Sinai's study examined a population older than any other previously published study that investigated minimally invasive heart surgeries, making it the first of its kind to report findings that can be of significant importance in the health of the elderly population.

The study was conducted by Joseph Lamelas, M.D. (Chief of Cardiac Surgery at Mount Sinai Medical Center), Gervasio Lamas, M.D. (Chief, Columbia University Division of Cardiology at Mount Sinai Medical Center), Orlando Santana, M.D. (Director of Echocardiography Laboratory, Columbia University Division of Cardiology at Mount Sinai Medical Center), and Alejandro Sarria, M.D. (Cardiology Fellow at Mount Sinai Medical Center).  There were 203 subjects, at least 75 years of age or older (mean age of 80) who underwent isolated valve surgery during the analysis period. Of these, 119 (59%) underwent minimally invasive surgery and 84 (41%) underwent a median sternotomy. All minimally invasive cases were performed by Mount Sinai's Chief of Cardiac Surgery, Dr. Joseph Lamelas, who performs the highest volume of cardiac surgeries in Florida and has the best cardiac surgical outcomes in South Florida *(for complex, high-volume cases).

In this study, when compared to the 84 patients who underwent a traditional median sternotomy, the 119 patients who underwent a minimally invasive valve surgery had significantly better outcomes that resulted in a:

• Lower percentage of complication rates during procedure (21% vs. 45%)
• Lower incidence of kidney failure (0.8% vs. 16.7%)
• Lower rate of wound infection (0.8% vs. 6%)
• Shorter intensive care unit stay (52 hours v. 119 hours)
• Shorter hospital stay (7 days vs. 12 days)

Overall, the Mount Sinai study results demonstrated that minimally invasive valve surgery is feasible and should be considered for older patients who might otherwise not have access to valve surgery due to high risk.