CARDIAC-SURGERY BY TRANSXIPHOID APPROACH WITHOUT STERNOTOMY

Objective: In a attempt to avoid the potential drawbacks associated wi th sternotomy coupled with a desire for a smaller scar led us to inves tigate the transxiphoid approach without sternotomy. We present our pr eliminary experience and a comparison between the sternal and thoracic approaches. Methods: From June 1996, at the Institut Cardiovasculaire Paris Sud, Massy, France (ICPS) and the Heart Institute, Sao Paulo, B razil (HI) the transxiphoid approach was adopted for the correction of selected congenital cardiac defects. The xiphoid was resected through a 6 cm long vertical skin incision. With a special retractor the ster num was elevated cephalad and anteriorly. Closure of the defect was pe rformed in the conventional manner. Twenty-six patients; 17 boys and 9 girls were entered into the study from representing 19 atrial septal defects (ASDs), 4 ventricular septal defects (VSDs) and 3 partial atri o ventricular septal defect (AVSDs). In addition at ICPS the transxiph oid approach for correction of ASD was compared to the thoracic and st ernal approaches performed in the same period. Results: Both the aorti c cross clamp time as well as the duration of extracorporeal circulati on were increased when compared to either standard sternotomy or thora cotomy approaches. There were no differences within the groups when co mparing body surface area, amount of chest drainage or length of eithe r ICU or hospital stay. However the patients in the transxiphoid,group showed less pain and respiratory discomfort. Conclusion: Our initial experience with the transxiphoid approach without sternotomy confirms that it is a promising technique that can be considered an alternative to conventional sternotomy. The access is adequate for surgical proce dures performed through a right atriotomy. The advantages include a be tter cosmetic scar, less surgical trauma, minimal respiratory discomfo rt and a potentially lower risk of infection. However cardiopulmonary bypass and cross clamp times are increased. There were no complication s, and patient satisfaction was high. (C) 1998 Elsevier Science B.V. A ll rights reserved.