LESS INVASIVE CARDIAC OPERATIONS THROUGH A MEDIAN STERNOTOMY - 100 CONSECUTIVE CASES

Background. In the beginning of 1997, we developed a routine approach to intracardiac operations through a less invasive median sternotomy. A limited (6 to 9 cm) median skin incision followed by a subcomplete ( manubrium and body) median sternotomy makes opening and closing of the chest easier; conventional central cardiopulmonary bypass is institut ed, and no modifications to the surgical techniques are necessary. Met hods. In 100 consecutive patients (mean age, 62.04 years; range, 9 to 92 years), 70 aortic, 13 mitral, and 17 other cardiac procedures were performed. Surgical technique required many self-made instruments; ane sthetic ''fast-tracking'' management was performed. Results. Four pati ents died. One conversion to a standard sternotomy and five reoperatio ns for bleeding were necessary. Cross-clamp time ranged from 33 to 140 minutes (mean +/- standard deviation, 69.23 +/- 20.99 minutes) and to tal drainage loss ranged from 120 to 1,800 mt, m(-2) . 24 h(-1) (mean, 288 mL . m(-2) . 24 h(-1)). The postoperative course was shorter than usual, and one complication in the healing wound was observed. The sc ar was shorter than 9 cm in all patients. Conclusions. Our work shows that a less invasive approach to many cardiac operations is possible t hrough a modified median sternotomy. This technique provides many pote ntial and practical advantages: there is less trauma and pain reported by patients, and the small wound reduces the risk of infection and bl ood loss. Patients are extubated and discharged from the hospital earl ier.