Outcomes of less invasive J-incision approach to aortic valve surgery

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Presentation transcript:

Outcomes of less invasive J-incision approach to aortic valve surgery Douglas R. Johnston, MD, Fernando A. Atik, MD, Jeevanantham Rajeswaran, MSc, Eugene H. Blackstone, MD, Edward R. Nowicki, MD, MS, Joseph F. Sabik, MD, Tomislav Mihaljevic, MD, A. Marc Gillinov, MD, Bruce W. Lytle, MD, Lars G. Svensson, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 144, Issue 4, Pages 852-858.e3 (October 2012) DOI: 10.1016/j.jtcvs.2011.12.008 Copyright © 2012 Terms and Conditions

Figure 1 Temporal pattern of postextubation forced 1-second expiratory volume (FEV1) as percent of predicted after less invasive and full sternotomy aortic valve surgery among propensity-matched patients. Solid lines are parametric estimates of temporal trend enclosed within dashed lines 68% confidence limits (equivalent to ±1 standard error). Symbols represent data grouped within time frames without regard for repeated assessment, simply to provide crude verification of model fit. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 852-858.e3DOI: (10.1016/j.jtcvs.2011.12.008) Copyright © 2012 Terms and Conditions

Figure 2 Temporal pattern of pain score categories after less invasive versus full sternotomy aortic valve surgery among propensity-matched patients. Symbols represent data grouped within time frames without regard for repeated assessment, simply to provide crude verification of model fit. Solid lines are parametric estimates of percentage of patients in each category. A, All pain score categories. B, Proportion of patients without pain (category 0). The Journal of Thoracic and Cardiovascular Surgery 2012 144, 852-858.e3DOI: (10.1016/j.jtcvs.2011.12.008) Copyright © 2012 Terms and Conditions

Figure 3 Survival after less invasive and full sternotomy aortic valve surgery among propensity-matched patients. Each symbol represents a death, positioned actuarially, vertical bars 68% confidence limits, and numbers in parentheses patients remaining at risk. Solid lines are parametric estimates enclosed within dashed 68% confidence limits (equivalent to ±1 standard error). The Journal of Thoracic and Cardiovascular Surgery 2012 144, 852-858.e3DOI: (10.1016/j.jtcvs.2011.12.008) Copyright © 2012 Terms and Conditions

Figure E1 Percent of aortic valve surgery performed through a less-invasive incision. This graph incorporates cases performed after the study period. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 852-858.e3DOI: (10.1016/j.jtcvs.2011.12.008) Copyright © 2012 Terms and Conditions

Figure E2 Mirrored histogram of distribution of propensity scores for full sternotomy (bars above zero line) and less invasive (bars below zero line) approaches. Darkened area represents matched patient pairs, showing that they cover the complete spectrum of cases. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 852-858.e3DOI: (10.1016/j.jtcvs.2011.12.008) Copyright © 2012 Terms and Conditions

Figure E3 Covariable balance plot before and after propensity-score matching on selected covariables. Symbols depict percent standardized differences17 for covariables between patients in less invasive and full sternotomy groups. BMI, Body mass index; BUN, blood urea nitrogen; COPD, chronic obstructive pulmonary disease; Dysfunct., dysfunction; HTN, hypertension; LV, left ventricular; Regurg., regurgitation; TV, tricuspid valve. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 852-858.e3DOI: (10.1016/j.jtcvs.2011.12.008) Copyright © 2012 Terms and Conditions