J-sternotomy incision for aortic valve surgery: an initial experience of a tertiary care hospital

Abstract

Objectives: This study aims to present our single-center experience of an aortic valve replacement using a minimally invasive J-sternotomy incision and to compare the early clinical outcomes of these procedures with a median sternotomy. Patients and methods:Between January 2014 and May 2015, 38 patients underwent isolated aortic valve replacement operations using a minimally invasive or a conventional sternotomy. A J-sternotomy (group JS) incision was used on 18 patients (12 males, 6 females; mean age 57.0±17.9 years; range 19 to 62 years), whereas a median sternotomy (group MS) incision was performed on 20 patients (13 males, 7 females; mean age 57.4±16.3 years; range 22 to 65 years). Preoperative characteristics, perioperative data and early outcomes were compared. Patient selection techniques, the surgical approach and our experience during the procedures were presented. Results:No mortality developed. The types (p=0.36) and dimensions (p=0.99) of implanted aortic valves were similar between the groups. There was no significant difference between the JS and MS groups in terms of cross-clamp (68.4±30.1 vs. 64.7±29.9 minutes, p=0.70) and cardiopulmonary bypass time (112.3±43.1 vs. 94.8±43.8 minutes, p=0.22). In the group JS, conversion to full sternotomy was needed in one patient due to poor surgical exposure. The lengths of intensive care unit [1.7±1.7 vs 2.2±1.2 days, (p=0.33)] and hospital [7.1±2.7 vs 7.2±1.2 days, (p=0.66)] stays were similar between the groups. A mediastinal exploration due to bleeding was performed using a full sternotomy in two patients (11.2%) from group JS. There was no significant difference in postoperative complications. Conclusion:Since it is minimally invasive for aortic valve replacement using a J-sternotomy incision is a safe and reproducible procedure. The use of a minimally invasive aortic valve replacement technique does not lead to a higher incidence of postoperative complications and associated mortality.