Abstract
Objective: In patients with pulmonary dysfunction, it is unclear whether a less-invasive approach for aortic valve replacement is well tolerated or even beneficial. We investigated whether a partial upper J-incision for aortic valve replacement leads to more favorable outcomes than a full sternotomy in patients with chronic lung disease by using forced expiratory volume in 1 second as a surrogate. Methods: From January 1995 to July 2010, 6931 patients underwent primary isolated aortic valve replacement; 655 had forced expiratory volume in 1 second measured and expressed as percent of predicted (FEV1%; 368 via J-incision, 287 via full sternotomy). Postoperative outcomes were compared among 223 propensity-matched pairs. Results: Patients diagnosed with chronic lung disease had longer median intensive care unit (41 vs 27 hours, P =.001) and postoperative (7.1 vs 6.1 days, P <.0001) lengths of stay than those without chronic lung disease. At normal values of FEV1%, little difference was observed in either of these times for J-incision versus full sternotomy; however, at progressively lower FEV1%, these times lengthened, with increasing benefit for J-incision. Among propensity-matched patients, other postoperative complications were similar. Early survival (93% vs 89% at 1 year, P =.07) was possibly higher in matched patients with J-incision, but late survival was similar (P =.9). Patients with FEV1% less than 50 who underwent J-incision had the greatest survival advantage, which persisted for 5 years. Conclusions: In patients with preoperative respiratory dysfunction, a less-invasive partial upper J-incision for aortic valve replacement can lead to more favorable outcomes than a full sternotomy, including shorter intensive care unit and postoperative lengths of stay and better early survival, which are amplified with decreasing pulmonary function.
Original language | English (US) |
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Pages (from-to) | 355-361.e5 |
Journal | Journal of Thoracic and Cardiovascular Surgery |
Volume | 147 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2014 |
Funding
Funding: This study was supported in part by the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (Dr Blackstone); the Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, James and Sharon Kennedy, the Slosburg Family Charitable Trust , Stephen and Saundra Spencer, and Martin Nielsen (Dr Pettersson); the Judith Dion Pyle Endowed Chair in Heart Valve Research (Dr Gillinov); the Donna and Ken Lewis Chair in Cardiothoracic Surgery and Peter Boyle Research Fund (Dr Mihaljevic); and the Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery (Dr Sabik).
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine
- Surgery