Outcomes of a Less-Invasive Approach for Proximal Aortic Operations

• Published in: The Annals of thoracic surgery Vol. 103; no. 2; pp. 533 - 540
• Main Authors: Levack, Melissa M., MD, Aftab, Muhammad, MD, Roselli, Eric E., MD, Johnston, Douglas R., MD, Soltesz, Edward G., MD, MPH, Gillinov, A. Marc, MD, Pettersson, Gösta B., MD, PhD, Griffin, Brian, MD, Grimm, Richard, DO, Hammer, Donald F., MD, Al Kindi, Adil H., MD, MS, Albacker, Turki B., MD, MS, Sepulveda, Edgardo, MD, Thuita, Lucy, MS, Blackstone, Eugene H., MD, Sabik, Joseph F., MD, Svensson, Lars G., MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2017
• Subjects: Adult; Aged; Aorta - surgery; Aortic Valve - physiopathology; Aortic Valve - surgery; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiothoracic Surgery; Cohort Studies; Female; Follow-Up Studies; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Hospital Mortality; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - mortality; Operative Time; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Propensity Score; Retrospective Studies; Sternotomy - methods; Sternotomy - mortality; Surgery; Survival Analysis; Thoracoscopy - methods; Thoracoscopy - mortality; Time Factors; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.06.008

Background Less-invasive techniques have previously been described for mitral and aortic valve operations; however, few studies have examined their benefit for aortic root and ascending aorta reconstruction. Using propensity matching, we compared outcomes of patients undergoing proximal aortic operations through a J incision compared with full sternotomy. Methods From January 1995 to January 2014, 8,533 patients underwent proximal aortic operations at Cleveland Clinic. The study population comprised 1,827 patients after those with prior cardiac operations, emergency procedures, endocarditis, or circulatory arrest were excluded; 568 (31%) underwent a J incision. A propensity score based on 57 variables was generated to account for differences in characteristics of full-sternotomy and J-incision patients, producing 483 matched patient pairs (85% of possible) for comparison of outcomes. Results Among propensity-matched patients, in-hospital mortality (0 [0%] J incision vs 2 [0.41%] full sternotomy; p  = 0.2), renal failure (3 [0.62%] vs 6 [1.2%]; p  = 0.3), stroke (3 [0.62%] vs 3 [0.62%; p > 0.9), reoperation for bleeding (17 [3.5%] vs 15 [3.1%]; p  = 0.7), intraoperative blood products (60 [15%] vs 78 [19%]; p  = 0.08), and postoperative transfusions (97 [20%] vs 103 [22%]; p  = 0.6) were similar. Intensive care unit (median 24 vs 26 hours) and postoperative hospital stays (median 5.2 vs 6.0 days) were shorter ( p < 0.0001) for the J incision, and operative and postoperative direct technical costs were 6% less. Conclusions A J incision is a feasible technique for primary isolated elective proximal aortic operations, with a low risk of complications similar to those of full sternotomy, but with the advantages of shorter intensive care unit and hospital stays, lower costs, and better cosmesis.