Mount Sinai Medical Center in Miami Beach, Florida, publishes landmark study
From The Miami Herald:
The European Journal of Cardio-Thoracic Surgery has published a first of its kind study conducted at Mount Sinai Medical Center of Florida reporting the outcomes of minimally invasive valve surgery versus traditional median sternotomy in patients with chronic obstructive pulmonary disease (COPD). 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 COPD patients, a smaller, less traumatic surgery would lead to better results. Minimally invasive valve surgery in these patients increased survival, reduced postoperative complications, and shortened length of hospital stay when compared with traditional median sternotomy surgery.
The study was conducted by Orlando Santana, M.D. (Director of Echocardiography Laboratory, Columbia University Division of Cardiology at Mount Sinai Medical Center); Gervasio Lamas, M.D.(Chief, Columbia University Division of Cardiology at Mount Sinai Medical Center); Joseph Lamelas, M.D. (Chief of Cardiac Surgery at Mount Sinai Medical Center); Javier Reyna, M.D. and Alexandre M. Benjo, M.D.
There were 165 subjects, at least 68 years of age or older, who underwent isolated valve surgery during the analysis period. Of these, 100 underwent minimally invasive surgery and 65 underwent a median sternotomy. All minimally invasive cases were performed by Mount Sinai's Chief of Cardiac Surgery, Dr. Joseph Lamelas, who has the highest volume of cardiac surgeries in Florida and the best cardiac surgical outcomes in Florida, among surgeons who perform the highest volume of complex cases.
In this study, when compared to the 65 patients who underwent a traditional median sternotomy, the 100 patients who underwent a minimally invasive valve surgery had significantly better outcomes that resulted in a:
- Lower percentage of complication rates during procedure (30% vs. 54%)
- Lower incidence of kidney failure (0% vs. 1.5%)
- Lower rate of infection (3% vs. 11%)
- Shorter intensive care unit stay (47 hours v. 73 hours)
- Shorter hospital stay (6 days vs. 9 days)
As many as 27% of patients who need to undergo cardiac surgery have a clinical history of COPD. Overall, the Mount Sinai study results demonstrated that minimally invasive valve surgery is feasible and should be considered for patients with chronic obstructive pulmonary disease.