• Fernando A Atik, Lars G Svensson, Eugene H Blackstone, A Marc Gillinov, Jeevanantham Rajeswaran, and Bruce W Lytle.
• Center for Aortic Surgery and the Marfan and Connective Tissue Disorder Clinic, Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
• J. Thorac. Cardiovasc. Surg. 2011 Jun 1;141(6):1461-8.e4.

ObjectiveLess invasive approaches to double-valve surgery are used for improved cosmesis; however, few studies have investigated their effect on outcome. We sought to compare these less invasive approaches with conventional full sternotomy.MethodsFrom January 1995 to January 2004, 114 patients underwent primary double-valve surgery through a less invasive approach and 381 through conventional sternotomy. Because there were important differences in the patients' characteristics, a propensity score based on 42 factors was used to obtain 81 well-matched patient pairs (71% of possible matches) for comparison of in-hospital morbidity and mortality, mediastinal drainage, transfusion requirements, pulmonary function, pain, and long-term survival.ResultsIn-hospital mortality was similar for propensity-matched patients: 6.2% (5/81) for those undergoing less invasive surgery and 2.5% (2/81) for those undergoing conventional sternotomy (P > .4). Occurrences of stroke (P > .9), renal failure (P = .4), myocardial infarction (P > .9), and infection (P > .9) were also similar. However, 24-hour mediastinal drainage was less after less invasive surgery (median, 250 vs 400 mL; P < .0001), but a similar proportion of patients received transfusions (28% vs 40%, P = .2). An equivalent proportion of patients were extubated in the operating room (7.7% vs 7.0%, P > .9), and median hours to extubation were similar (5.0 vs 6.5 hours). Pain scores were equivalent (P > .3). Long-term survival was also similar (82% and 76% at 10 years, P = .07).ConclusionsWithin that portion of the spectrum of double-valve surgery in which propensity matching was possible, less invasive surgery had cosmetic and blood product use advantages over conventional surgery and no apparent detriments.Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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