The Annals of Thoracic Surgery ( January, 2011) has just published a first of its kind 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.
“The implications of this study are huge. Basically, at Mount Sinai, we can now prolong life expectancy in a population that, otherwise, was not given the interventional care they need because they were labeled as high-risk patients. The elderly with heart disease, and their adult children, need to know that they dohave options for surgical intervention,” said Dr. Joseph Lamelas, chief of cardiac surgery at Mount Sinai and one of the principal investigators in this study.
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 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).
George Freeland, a 79-year old retiree, has had cardiovascular disease for some time. Before deciding to explore surgical interventions, Mr. Freeland had to consider whether his age would be a factor in having surgery. After learning that Mount Sinai performs the highest volume of cardiac surgeries in all of Florida, he decided to have Dr. Lamelas perform his minimally invasive valve surgery in late 2010.
“It made sense to me to have my surgery done at a hospital proven to have the most experience in this type of surgery. Since I had my surgery, I have felt great! I just turned 79 but I still feel like I have a lot of life left in me,” said Freeland.
Though advanced age has, in the past, been a major predictor of poor outcome in patients undergoing valve surgery, Mr. Freeland is a prime example of a patient who contradicts that norm.
“If there is one thing we hope people will remember it’s that if you are a high-risk patient, you should be looking for the least invasive method for surgery and that’s exactly what we offer at Mount Sinai Medical Center,” said Dr. Gervasio Lamas, Mount Sinai’s chief of cardiology.
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.
Mount Sinai Medical Center’s study can be found in the Annals of Thoracic Surgery (January, 2011):
Outcomes of Minimally Invasive Valve Surgery Versus Median Sternotomy in Patients Age 75 Years or Greater
Joseph Lamelas, Alejandro Sarria, Orlando Santana, Andres M. Pineda, and Gervasio A. Lamas Annals of Thoracic Surgery, 2011; 91:79-84.
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