Partial Upper Sternotomy for Concomitant with Ascendant Aorta Replacement or Isolated Aortic Valve Implantation

Abstract

Introduction: Less-invasive procedures have gained more widespread adoption among cardiovascular surgeons as a result of continuous advances in the field of cardiac surgical techniques. It has now become clear that even smaller incisions may provide adequate exposure in certain cardiac surgical procedures without compromising the surgeon's view of the surgical field. Furthermore, a limited incision offers the advantage of cosmetic outcomes, hence an improved quality-of-life after the operation. Herein, we report our experience regarding the use of partial upper sternotomy with limited skin incision for isolated or combined aortic valve operations. Patients and Methods: A total of 34 patients underwent aortic valve surgery via partial J-shaped upper sternotomy in two separate centers between January 2013 and December 2014. Sixteen patients (47%) underwent an isolated aortic valve replacement, while 18 patients (53%) underwent a modified Bentall procedure. Descriptive data included demographic and clinical outcome parameters. Results: Mean age was 54 ± 14 years (range: 19 to 82 years) and there were 11 females (32%). The average duration of surgery was 6.8 ± 1.8 hours, ranging from 4 to 10 hours. Early mortality occurred in 1 patient. Two patients had wound infection and they were re-hospitalized for wound care. Conclusion: Our preliminary result regarding the use of partial upper ministernotomy is encouraging. The technique allows adequate exposure during aortic valve surgery, even in procedures involving the proximal ascending aorta. Further studies are warranted to test the safety and efficacy of this approach.