Minimally Invasive Valvular Surgery in the Elderly ― Safety, Early Recovery, and Long-Term Outcomes ―
| Autor: | Kazuki, Hisatomi, Takashi, Miura, Kikuko, Obase, Ichiro, Matsumaru, Shun, Nakaji, Akihiko, Tanigawa, Shunsuke, Taguchi, Masayuki, Takura, Yuko, Nakao, Kiyoyuki, Eishi |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Circulation Journal. 86:1725-1732 |
| ISSN: | 1347-4820 1346-9843 |
| DOI: | 10.1253/circj.cj-22-0338 |
| Popis: | 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.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.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. |
| Databáze: | OpenAIRE |
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