Minimally Invasive Cardiac Surgery Using Lower Hemisternotomy Approach: Our Initial Experience With 51 Cases
Gauranga Majumdar, Surendra Agarwal, Shantanu Pande, Bipin Chandra.
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
OBJECTIVE: we share our initial experiences with lower hemisternotomy approach in 51 cases.
METHODS: Patients with morbid obesity, emergency surgery, severe pulmonary arterial hypertension and redo surgery was not included in this study. Primary median Lower hemisternotomy was performed without any lateral extension. Slow and gradual opening a crucial step in preventing sternal fracture. Roberts’s retractor was used to pull the Aorta for cannulation. Straight high flow aortic cannula was preferred in most of the cases. Cardio pulmonary Bypass was established (aortic & bicaval) with routine instruments and cannula.
RESULTS: Between January 2014 to December 2015, 51 patients (23 male and 28 female, age ranges: 15-62yrs) with ASD (n= 21) mitral valve(30), Mitral and aortic valve(01), tricuspid valve diseases (5)predominantly due to rheumatic heart disease have been operated on by this technique. Mitral valve replacement was done in all 30 valvular patients .one patient underwent DVR, three patient TV repair with Teflon ring annuloplasty, large LA clot removal in two patients and LA placation was done in 5 patients. There was no peri-operative mortality. Two patient required conversion to full sternotomy. Mean ACC time 27.5 min (18-45) time and mean CPB time 45.7 min (35-65) time.Average intensive unit stay and hospital stay was 1.3 and 5.5 days. Follow up of the remaining 49 patients’ ranges from 12 months to 36 months . No procedure related complication observed in this group of patients.
CONCLUSIONS: Minimally invasive surgery through lower hemisternotomy is safe, effective, and cosmetically acceptable procedure which do not require extra financial burden as can be done using routine instruments. The advantages are Central cannulation, Easy access to ventricle , Easy of extension if required , Cosmetically acceptable and Preserves manubrium & shoulder function ,Prevents sternal dehiscence in case of infection. This procedure is easily reproducible with equal efficacy and safety in comparison with conventional technique.
Legends: A: MVR B: MVR with LA clot C: DVR D: incision E : ASD
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