title: Outcomes of less invasive J-incision approach to aortic valve surgery.
abstract: OBJECTIVE
  Less invasive approaches to aortic valve surgery are increasingly used; however, few studies have investigated their impact on outcome. We sought to compare clinical outcomes after these approaches with full sternotomy using propensity-matching methods.
  
  
  METHODS
  From January 1995 to January 2004, a total of 2689 patients underwent isolated aortic valve surgery, 1193 via upper J-hemisternotomy and 1496 via full sternotomy. Because of important differences in patient characteristics between these groups, a propensity score based on 42 variables was used to obtain 832 well-matched patient pairs (70% of possible cases).
  
  
  RESULTS
  In-hospital mortality was identical for propensity-matched patients, 0.96% (8 in each). Occurrences of stroke (P > .9), renal failure (P = .8), and myocardial infarction (P = .7) were similar. However, 24-hour mediastinal drainage was a third less after less invasive surgery (median, 250 vs 350 mL; P < .0001), and fewer patients received transfusions (24% vs 34%; P < .0001). More patients undergoing less invasive surgery were extubated in the operating room (12% vs 1.6%; P < .0001), postoperative forced 1-second expiratory volume was higher (P = .009), and fewer had respiratory failure (P = .01). Early after operation, pain scores were lower (P < .0001) after less-invasive surgery and postoperative length of stay shorter (P < .0001).
  
  
  CONCLUSIONS
  Within that portion of the spectrum of isolated aortic valve surgery where propensity matching was possible, minimally invasive aortic valve surgery had not only cosmetic advantages, but blood product use, respiratory, pain, and resource utilization advantages over full sternotomy, and no apparent detriments. Less invasive aortic valve surgery should be considered for most aortic valve operations.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Johnston
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Atik
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Edward R
authors.initials: ER
authors.lastname: Nowicki
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009820:Ohio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult