"J" incision minimal-access valve operations

Having used various minimal access incisions in 45 patients and our approach of "J" incisions, we wished to evaluate results with the latter incision.

Between January 1997 and September 1997, 33 consecutive unselected patients underwent minimal access aortic valve operations (n = 25, including 4 composite grafts [1 hemiarch, 1 transaortic MVR], 2 root and valve repairs, and 1 double valve replacement), mitral valve operations (n = 6, 4 repairs, 2 replacements, including 1 maze procedure), or atrial septal defect repairs through "J" incisions (n = 2).

One patient with preoperative severe pulmonary disease died of adult respiratory distress syndrome (3%, 1/33). The mean cross-clamp and bypass times were 85.9 minutes and 113.5 minutes, although for recent isolated aortic valve replacement operations the mean was 44 minutes (range, 39 to 51 minutes). Mean operative blood use was 0.33 units, and no patient required reoperation for bleeding. The mean time before extubation, intensive care unit stay, and postoperative stay were 0.44 days, 0.58 days, and 4.8 days. No strokes occurred. Mean postoperative pain medication requirements were 22.9 mg of morphine and 7.1 oral narcotic doses.

"J" incisions are safe alternatives to other incisions, result in good exposure, do not require division of the mammary arteries, minimize postoperative pain medication requirements, and, with experience, can be performed with acceptable aortic cross-clamp times.