They found a similar prevalence of post-operative AF using either method, even after stratifying for valve type. However, the PAIR registry reported a 10% incidence of new-onset AF with the port access technique, which is lower than that Pazopanib msds expected for sternotomy [33]. 8. Septic Complications The incidence of wound infections and septic complications is lower with a thoracotomy than with a median sternotomy. Of the three studies of minithoracotomy mitral valve surgery that reported wound complications compared to median sternotomy, Grossi et al. reported an incidence of 0.9% and 5.7% for minithoracotomy and sternotomy cases, respectively (P = 0.05) [34]. This increased to 1.8% and 7.7%, respectively, in elderly patients (P = 0.03) [34], whereas Felger et al. reported no significant difference [30].

9. Pain, Quality of Life and Speed of Recovery Compared with a complete sternotomy, thoracotomy incisions are associated with less pain, discomfort, and postoperative analgesics [30]. Cohn’s data show less pain in hospital and after discharge, less analgesic usage, greater patient satisfaction, and a return to normal activity 4.8 weeks ahead of sternotomy patients [8]. The most insightful evidence comes from 2 studies reporting that patients undergoing surgery via a minimally invasive approach as their second procedure all thought that their recovery was faster/less painful than their original sternotomy [30, 79]. 10. Elderly Patients Iribarne et al. demonstrated that MIMVS can be performed safely in patients at ��75 years old [80].

Although the minimally invasive approach was associated with slightly longer CPB and cross clamp times than was the conventional sternotomy approach, there were no significant differences in postoperative morbidity and mortality. Importantly, patients undergoing MIMVS had approximate 3 days shorter mean and 1 day shorter median durations of hospitalization, a finding that has important implications for resource use. There were significant reductions in both mean and median costs of hospitalization associated with the minimally invasive approach, a finding that correlates with the observed difference in duration of hospitalization found between the groups. In addition, patients undergoing MIMVS had faster rates for both time to independent ambulation and time to independent sit-to-stand activity [80]. Grossi et al.

analyzed 111 patients undergoing MIMVS who were at least 70 years old and compared these to 259 patients having a sternotomy AV-951 and concluded that this approach can be used safely in operations on the elderly population with excellent result [34]. Felger et al. recently reported 123 cases of minimal invasive mitral valve repair in patients aged ��70 years with 1.6% operative mortality as well as 5-year actuarial survival of 87% and 5-year freedom from reoperation of 93% [30, 79].