Should less-invasive aortic valve replacement be avoided in patients with pulmonary dysfunction?

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, Lars G. Svensson

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


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 =.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. 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.

Original languageEnglish
Pages (from-to)355-361.e5
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number1
StatePublished - Jan 2014

Bibliographical note

Funding Information:
Funding: This study was supported in part by the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (Dr Blackstone); the Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, James and Sharon Kennedy, the Slosburg Family Charitable Trust , Stephen and Saundra Spencer, and Martin Nielsen (Dr Pettersson); the Judith Dion Pyle Endowed Chair in Heart Valve Research (Dr Gillinov); the Donna and Ken Lewis Chair in Cardiothoracic Surgery and Peter Boyle Research Fund (Dr Mihaljevic); and the Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery (Dr Sabik).

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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