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OBJECTIVE: We report our clinical experience with a new technique of aortic valve replacement by minimal access complete median sternotomy via a midline skin incision of maximum 9 cm. This technique was used in patients with high age and multiple co-morbidities, facilitating an easy access with short bypass and cross clamp time. It was especially performed in women with the need of an excellent cosmetic result, not qualifying for minimal invasive AVR by partial upper sternotomy.
METHODS:Aortic valve replacement by minimal Access median sternotomy, was performed in 31 patients between 01/2009 and 07/2011. Intra- and postoperative data including cross clamp time, cardiopulmonary bypass time, mortality, stroke, pacemaker implantation, re-operation for bleeding, ventilation time, ICU and hospital stay, wound infection, sternal dehiscence or fracture and 30 day mortality were collected.
RESULTS:Mean patients age was 76,3 +/-10,5 years, 71 % were female. Minimal Access Aortic valve replacement could be performed with a mean length of midline skin incision of 8,2 cm. Cross-clamping time was 55,9 +/-7,5 min, cardiopulmonary bypass time 75,6+/-13,9 min and time of surgery 164,4 +/-25,9 min. Re-operation for bleeding had to be performed in 1 case (3,3%). There were no strokes or pacemaker implantations needed. Mean ventilation time was 4,5h, ICU stay was 2 days and mean length of hospital stay was 6 days. Thirty day mortality was 0% and no sternal dehiscence or wound infection was observed.
CONCLUSIONS:AVR by minimal access complete median sternotomy can be performed safe, combining excellent cosmetic results with fast time of surgery and postoperative recovery.