- 作者：Turki B. Albacker ; Eugene H. Blackstone ; Sarah J. Williams ; A. Marc Gillinov ; Jose L. Navia ; Eric E. Roselli ; Suresh Keshavamurthy ; G枚sta B. Pettersson ; Tomislav Mihaljevic ; Douglas R. Johnston ; Joseph F. Sabik III ; Bruce W. Lytle ; Lars G. Svensson
- 关键词：AVR ; aortic valve replacement ; CABG ; coronary artery bypass grafting ; CLD ; chronic lung disease ; FEV1 ; forced expiratory volume in 1 second ; FEV1% ; forced expiratory volume in 1 second ; percent of predicted ; ICU ; intensive care unit
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：January, 2014
- 年：2014
- 卷：147
- 期：1
- 页码：355-361.e5
- 全文大小：1322 K
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聽=聽.001) and postoperative (7.1 vs 6.1 days, P聽<聽.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聽1聽year, P聽=聽.07) was possibly higher in matched patients with J-incision, but late survival was similar (P聽=聽.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.