• Jarosław Stoliński, Dariusz Plicner, Bogusław Gawęda, Robert Musiał, Kamil Fijorek, Marcin Wąsowicz, Janusz Andres, and Bogusław Kapelak.
• Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland. Electronic address: jstolinski@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2016 Oct 1; 30 (5): 1244-53.

ObjectiveTo compare the function of the respiratory system after aortic valve replacement through median sternotomy (AVR) or the minimally invasive right anterior minithoracotomy (RAT-AVR) approach among elderly (aged≥75 years) patients.DesignObservational cohort study.SettingsUniversity hospital.ParticipantsThe study included 65 elderly patients scheduled for RAT-AVR and 82 for standard AVR.InterventionsPulmonary function tests (PFT) were performed preoperatively, 1 week, 1 month, and 3 months after surgery. In addition, respiratory complications were analyzed.Measurements And Main ResultsRespiratory complications occurred in 12.3% of patients in the RAT-AVR group and 18.3% of patients in the AVR group (p = 0.445). Mechanical ventilation time in the intensive care unit was 7.7±3.6 hours for RAT-AVR patients and 9.7±5.4 hours for AVR patients (p = 0.003). Most PFT were worse in the AVR group than in the RAT-AVR group when performed 1 week after surgery. After 1 month, forced expiratory volume in the first second, vital capacity, and total lung capacity differed significantly in favor of the RAT-AVR group (p = 0.002, p<0.001, and p = 0.001, respectively). After 3 months, the PFT parameters still had not returned to preoperative values, but the differences were no longer significant between the RAT-AVR and AVR groups. The multivariable median regression analysis demonstrated that RAT-AVR surgery was a key factor in a patient's higher postoperative PFT parameter values.ConclusionsRAT-AVR surgery resulted in shorter postoperative mechanical ventilation time and improved the recovery of pulmonary function in elderly patients, but it did not reduce the incidence of pulmonary complications when compared with surgery performed through a median sternotomy.Copyright © 2016 Elsevier Inc. All rights reserved.

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