Outcomes of a Less-Invasive Approach for Proximal Aortic Operations

Melissa M. Levack, Muhammad Aftab, Eric E. Roselli, Douglas R. Johnston, Edward G. Soltesz, A. Marc Gillinov, Gösta B. Pettersson, Brian Griffin, Richard Grimm, Donald F. Hammer, Adil H. Al Kindi, Turki B. Albacker, Edgardo Sepulveda, Lucy Thuita, Eugene H. Blackstone, Joseph F. Sabik, Lars G. Svensson*

*المؤلف المقابل لهذا العمل

نتاج البحث: المساهمة في مجلةArticleمراجعة النظراء

12 اقتباسات (Scopus)


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.

اللغة الأصليةEnglish
الصفحات (من إلى)533-540
عدد الصفحات8
دوريةAnnals of Thoracic Surgery
مستوى الصوت103
رقم الإصدار2
المعرِّفات الرقمية للأشياء
حالة النشرPublished - فبراير 1 2017

ASJC Scopus subject areas

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