Minimally Invasive Cardiac Surgery: A Safe Alternative for Aortic Valve

Over the past 50 years, surgical aortic valve replacement with cardiopulmonary bypass has been the most widely employed strategy for the treatment of symptomatic aortic stenosis. Advances in prosthetic technology have contributed to improvements both in valve design and in the techniques used in surgical implantation. More recently, minimally invasive surgery for aortic valve replacement has undergone a change in the paradigm used since its introduction 2 decades ago. When first instituted, traditionalist surgeons rejected techniques of this type because of safety concerns due to the reduced surgical exposure as compared to the standard approach. However, as a result of subsequent development, innovation, and surgical refinement in this area, the operative outcomes are similar or even superior to the success achieved using traditional management. For these reasons, minimally invasive surgery has become a safe and effective treatment that reduces complications and increases patient satisfaction. However, to date no prospective, randomized, multicenter studies have compared the minimally invasive technique with the standard procedure, as would be desirable. Endeavors that enable the retrospective comparison and analysis of the results from different centers specialized in this area are essential. In the article published in the Revista Española de Cardiologı́a, Paredes et al. present a retrospective analysis that compares the surgical outcomes of patients who underwent minimally invasive aortic valve replacement with those resulting from the performance of full sternotomy. The technique used by the authors for minimally invasive aortic valve replacement is that which is most widely accepted by other professionals: ministernotomy with a J-shaped incision from the sternal notch to the third or fourth right intercostal space. The comparative analysis was based on the medical records of 615 patients treated between 2005 and 2012. A minimally invasive approach was used in 83 of these patients. The criteria for evaluating the outcome of the procedure included, among other