J-shaped versus median sternotomy for aortic valve replacement with minimal extracorporeal circuit

Figures & data

Table I. Baseline patient characteristics.

	Upper J-shaped sternotomy n = 104	Standard median sternotomy n = 72	p-value
Age (years)	66.2 ± 14.4	69.3 ± 12.3	0.1415
Gender male/female	52/52	34/38	0.8344
BMI (kg/m^2)	27.1 ± 4.3	27.7 ±.8	0.4321
COPD	17 (23%)	9 (9%)	0.0122
Preoperative AMI	5 (4%)	3 (5%)	0.8891
Diabetes	18 (18%)	9 (13%)	0.4459
Hypertension	44 (43%)	36 (50%)	0.4253
Active smoker	19 (18%)	9 (13%)	0.4126
Hypercholesterolemia	31 (30%)	25 (35%)	0.5569
Preoperative haemoglobin	13.6 ± 1.5	13.5 ± 1.4	0.5720
Aortic stenosis	90 (87%)	62 (86%)	0.8870
Aortic insufficiency	52 (51%)	36 (50%)	0.9569
Mixed AS and AI	39 (38%)	27 (38%)	0.8954
Ejection fraction (%)	57.6 ± 9.8	58.6 ± 9.5	0.6152
Previous cardiac surgery	4 (4%)	3 (4%)	0.7658

Body mass index, BMI; chronic obstructive pulmonary disease, COPD; acute myocardial infarction, AMI; aortic stenosis, AS; aortic insufficiency, AI.

Table II. Intraoperative data.

	Upper J-shaped ternotomy n = 104	Standard median sternotomy n = 72	p-value
Cross-clamp time (min)	65 ± 13	59 ± 12	0.0013
Mean CPB time (min)	86 ± 18	78 ± 15	0.0079
Total operation time (min)	155 ± 25	148 ± 27	0.0571
Biological prostheses	73 (70%)	52 (72%)	0.9022
Mechanical prostheses	31 (30%)	20 (28%)

Cardiopulmonary bypass, CPB.

Table III. Postoperative complications and transfusion requirements.

	Upper J-shaped sternotomy n = 104	Standard median sternotomy n = 72	p-value
Intraoperative mortality	0	0	na
Use of IABP	1 (1%)	0	0.8979
Neurological events	1 (1%)	1 (1%)	0.6454
Re-exploration for bleeding	2 (1%)	1 (2%)	0.7467
Wound/sternal infection	0	0	na
Haemoglobin drop (g/dl)	2.3 ± 1.4	2.1 ± 1.3	0.4180
Renal failure postoperative (creatinine >150 mmol/l)	0	0	na
Arrhythmias	19 (18%)	22 (30%)	0.0864
30 day mortality	0 (0%)	1 (1%)	0.9539
Intubation time (h)	8 ± 6.9	11 ± 16.5	0.0054
ICU stay (days)	1.7 ± 1.3	2.4 ± 5.2	0.1939
Number of patients transfused intraoperatively	1 (1%)	0
Total units packed cells	1	0	0.8923
Thrombocytes	0	0	na
FFP	0	0	na
Number of patients transfused postoperatively	23 (22%)	17 (24%)
Total units packed cells	36	28	0.7535
Thrombocytes	8	7	0.4168
FFP	15	21	0.4882
Chest tube drainage (ml)	397 ± 257	614 ± 339	<0.0001

Cardiopulmonary bypass, CBP; intra-aortic balloon pump, IABP; not applicable, na; intensive care unit, ICU; fresh frozen plasma, FFP.

Figure 1. Figure 1. a, b. Quality of life (SF-12) scores. c. Restrictions in daily activities, 1 = always, 2 = usually, 3 = sometimes, 4 = seldom, 5 = never. *significant difference between scores.