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

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)533-540
Number of pages8
JournalAnnals of Thoracic Surgery
Volume103
Issue number2
DOIs
Publication statusPublished - Feb 1 2017

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Sternotomy
Intensive Care Units
Length of Stay
Costs and Cost Analysis
Propensity Score
Hospital Mortality
Endocarditis
Aortic Valve
Mitral Valve
Reoperation
Renal Insufficiency
Aorta
Emergencies
Stroke
Hemorrhage
Population

ASJC Scopus subject areas

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

Cite this

Levack, M. M., Aftab, M., Roselli, E. E., Johnston, D. R., Soltesz, E. G., Gillinov, A. M., ... Svensson, L. G. (2017). Outcomes of a Less-Invasive Approach for Proximal Aortic Operations. Annals of Thoracic Surgery, 103(2), 533-540. https://doi.org/10.1016/j.athoracsur.2016.06.008

Outcomes of a Less-Invasive Approach for Proximal Aortic Operations. / Levack, Melissa M.; Aftab, Muhammad; Roselli, Eric E.; Johnston, Douglas R.; Soltesz, Edward G.; Gillinov, A. Marc; Pettersson, Gösta B.; Griffin, Brian; Grimm, Richard; Hammer, Donald F.; Al Kindi, Adil H.; Albacker, Turki B.; Sepulveda, Edgardo; Thuita, Lucy; Blackstone, Eugene H.; Sabik, Joseph F.; Svensson, Lars G.

In: Annals of Thoracic Surgery, Vol. 103, No. 2, 01.02.2017, p. 533-540.

Research output: Contribution to journalArticle

Levack, MM, Aftab, M, Roselli, EE, Johnston, DR, Soltesz, EG, Gillinov, AM, Pettersson, GB, Griffin, B, Grimm, R, Hammer, DF, Al Kindi, AH, Albacker, TB, Sepulveda, E, Thuita, L, Blackstone, EH, Sabik, JF & Svensson, LG 2017, 'Outcomes of a Less-Invasive Approach for Proximal Aortic Operations', Annals of Thoracic Surgery, vol. 103, no. 2, pp. 533-540. https://doi.org/10.1016/j.athoracsur.2016.06.008
Levack MM, Aftab M, Roselli EE, Johnston DR, Soltesz EG, Gillinov AM et al. Outcomes of a Less-Invasive Approach for Proximal Aortic Operations. Annals of Thoracic Surgery. 2017 Feb 1;103(2):533-540. https://doi.org/10.1016/j.athoracsur.2016.06.008
Levack, Melissa M. ; Aftab, Muhammad ; Roselli, Eric E. ; Johnston, Douglas R. ; Soltesz, Edward G. ; Gillinov, A. Marc ; Pettersson, Gösta B. ; Griffin, Brian ; Grimm, Richard ; Hammer, Donald F. ; Al Kindi, Adil H. ; Albacker, Turki B. ; Sepulveda, Edgardo ; Thuita, Lucy ; Blackstone, Eugene H. ; Sabik, Joseph F. ; Svensson, Lars G. / Outcomes of a Less-Invasive Approach for Proximal Aortic Operations. In: Annals of Thoracic Surgery. 2017 ; Vol. 103, No. 2. pp. 533-540.
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abstract = "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.",
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T1 - Outcomes of a Less-Invasive Approach for Proximal Aortic Operations

AU - Levack, Melissa M.

AU - Aftab, Muhammad

AU - Roselli, Eric E.

AU - Johnston, Douglas R.

AU - Soltesz, Edward G.

AU - Gillinov, A. Marc

AU - Pettersson, Gösta B.

AU - Griffin, Brian

AU - Grimm, Richard

AU - Hammer, Donald F.

AU - Al Kindi, Adil H.

AU - Albacker, Turki B.

AU - Sepulveda, Edgardo

AU - Thuita, Lucy

AU - Blackstone, Eugene H.

AU - Sabik, Joseph F.

AU - Svensson, Lars G.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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.

AB - 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.

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