• Turki B Albacker, Eugene H Blackstone, Sarah J Williams, A Marc Gillinov, Jose L Navia, Eric E Roselli, Suresh Keshavamurthy, Gösta B Pettersson, Tomislav Mihaljevic, Douglas R Johnston, Joseph F Sabik, Bruce W Lytle, and Lars G Svensson.
• Department of Thoracic and Cardiovascular Surgery and Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
• J. Thorac. Cardiovasc. Surg.. 2014 Jan 1;147(1):355-361.e5.

ObjectiveIn 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.MethodsFrom 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.ResultsPatients 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.ConclusionsIn 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.Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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