I would not think twice about minimally invasive AVR .....Its being split open I don't like
I'm a big believer in surgeon shopping, but not procedure shopping. In my view, you choose the surgeon and clinic you want to perform your operation and then go with their recommendation on what they think is best on whether a full sternotomy or more minimal procedure is the right course.
I met with 3 different surgeons before deciding on which one to go with.
Personally, my criteria was that ideally I wanted the surgeon to meet the following 3 criteria:
1. A top rated clinic
2. A surgeon who had excellent survival statistics- significantly better than the national average
3. A surgeon who was very experienced- with many thousands of surgeries like mine under his belt.
Two of the surgeons I met with met the above- both of them the head of cardiac surgery at their institution.
Some may find this interesting- This study found that surgeon volume matters in terms of outcomes for SAVR:
https://www.annalsthoracicsurgery.org/article/S0003-4975(11)02302-2/fulltext
I was perfectly happy to get a full sternotomy if that was the surgeon's choice, but he felt that a mini-sternotomy was the right technique for my condition. I did not question it, nor was it really presented to me as a choice. Although perhaps if I lobbied him for a full he would have obliged. He has done several thousand mini-sternotomies, and his rate of patient survival is far above national average, in fact one of the highest I had ever seen, so I had great confidence in his ability to perform what he needed to do, even though the opening was smaller than a full sternotomy. And, all things being equal, especially outcomes, I was glad that he recommended the mini.
As I understand it, the main advantage of the minimally invasive procedures is the quicker healing time. I believe that the rates of mortality are the same. Dr. Doug Johnson at Cleveland Clinic acknowledged this in one talk, indicating that outcomes are not improved, but they have started doing a lot more minimally invasive procedures due to patient demand. I found that interesting.
Most patients are going to want the most minimally invasive procedure possible. This is certainly one reason why TAVR has grown in popularity, despite no evidence that long term outcomes are any better than SAVR, in fact they are worse at 5 years. That is troubling to me, although I do see TAVR as an advantage if SAVR is not an option due to the patient being in the very high risk category for SAVR.