The advantage of minimally invasive sternotomy (MS) over full sternotomy (FS) for isolated aortic valve replacement (AVR) is still controversial. We aimed to examine if J-shaped MS is a safe alternative to FS in patients undergoing primary isolated AVR. This study is a retrospective and restricted cohort study that included 137 patients who had primary isolated AVR from February 2013 to June 2015. Patients with previous cardiac operations, low ejection fraction (< 40%), infective endocarditis, EuroSCORE II predicted mortality > 10%, and patients who had inverted T or inverted C-MS or right anterior thoracotomy were excluded. Patients were grouped into the FS group (n=65) and MS group (n=72). Preoperative variables were comparable in both groups. The outcome was studied, balancing the groups by propensity score matching. Seven (9%) patients in the MS group were converted to FS. Cardiopulmonary bypass (98.5 ± 29.3 vs. 82.1 ± 13.95 min; p ≤ 0.001) and ischemic times (69.1 ± 23.8 vs. 59.6 ± 12.2 min; p = 0.001) were longer in MS. The MS group had a shorter duration of mechanical ventilation (10.1 ± 11.58 vs. 10.9 ± 6.43 h; p = 0.045), ICU stay (42.74 ± 40.5 vs. 44.9 ± 39.3; p = 0.01), less chest tube drainage (385.3 ± 248.6 vs. 635.9 ± 409.6 ml; p = 0.001), and lower narcotics use (25.14 ± 17.84 vs. 48.23 ± 125.68 mg; p < 0.001). No difference was found in postoperative heart block with permanent pacemaker insertion or atrial fibrillation between groups (p = 0.16 and 0.226, respectively). Stroke, renal failure, and mortality did not differ between the groups. Reintervention-free survival at 1, 3, and 4 years was not significantly different in both groups (p = 0.73). J-ministernotomy could be a safe alternative to FS in isolated primary AVR. Besides the cosmetic advantage, it could have better clinical outcomes without added risk.

中文翻译：

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J 型主动脉瓣置换术：一项回顾性队列研究

对于孤立的主动脉瓣置换术 (AVR)，微创胸骨切开术 (MS) 相对于全胸骨切开术 (FS) 的优势仍存在争议。我们旨在检查 J 形 MS 是否是接受原发性孤立性 AVR 的患者的 FS 的安全替代方案。本研究是一项回顾性和限制性队列研究，包括 2013 年 2 月至 2015 年 6 月间发生原发性孤立性 AVR 的 137 名患者。 曾接受过心脏手术、射血分数低 (< 40%)、感染性心内膜炎、EuroSCORE II 预测死亡率 > 10% 的患者，并排除了倒 T 或倒 C-MS 或右前开胸手术的患者。患者分为FS组（n=65）和MS组（n=72）。两组的术前变量具有可比性。研究了结果，通过倾向得分匹配来平衡各组。MS 组中有 7 名 (9%) 患者转变为 FS。体外循环（98.5 ± 29.3 对 82.1 ± 13.95 分钟；p ≤ 0.001）和缺血时间（69.1 ± 23.8 对 59.6 ± 12.2 分钟；p = 0.001）在 MS 中更长。MS 组的机械通气时间较短（10.1 ± 11.58 对 10.9 ± 6.43 小时；p = 0.045），ICU 住院时间（42.74 ± 40.5 对 44.9 ± 39.3；p = 0.01），胸管引流较少（385.3 ± 248.6 与 635.9 ± 409.6 毫升；p = 0.001），以及较低的麻醉品使用（25.14 ± 17.84 与 48.23 ± 125.68 毫克；p < 0.001）。两组间植入永久性起搏器或心房颤动的术后心脏传导阻滞无差异（分别为 p = 0.16 和 0.226）。卒中、肾功能衰竭和死亡率在各组之间没有差异。两组的 1、3 和 4 年无再干预生存率无显着差异（p = 0. 73)。J-ministernotomy 可能是孤立性原发性 AVR 中 FS 的安全替代方案。除了美容优势外，它还可以在不增加风险的情况下获得更好的临床结果。