Minimally invasive aortic valve replacement via hemi-sternotomy: a preliminary report.

OBJECTIVE

Aortic valve replacement has been approached by standard sternotomy. We described a technique of aortic valve replacement where the aortic valve is exposed through a hemi-sternotomy. Good exposure is obtained for aortic valve surgery with standard aortic and right atrial cannulation to establish cardiopulmonary bypass (CPB).

METHODS

From October 1996 to April 1997, 19 consecutive aortic valve replacements (AVR) via hemi-sternotomy were performed by one surgeon. The results were collected and analysed prospectively. Results are expressed as mean +/- standard deviation. Nineteen patients (13 male, 6 female) had AVR with this approach. Two cases were redo AVR. The mean age was 58+/-15 years. The New York Heart Association (NYHA) class was 2.8+/-0.7.

RESULTS

Aortic cross clamp time was 54+/-13 min. One of six patients requiring defibrillation after reperfusion needed conversion to full sternotomy. Four patients were extubated at the conclusion of surgery. One patient died 4 h postoperatively from low cardiac output. All patients had normal valvular function demonstrated on postoperative transoesophageal echocardiography. There were no neurological events.

CONCLUSIONS

Minimally invasive aortic valve replacement can be safely performed via hemi-sternotomy with standard equipment. Less surgical trauma to the sternum has the potential benefit of less pain and shorter intensive care and hospital stay.