LESS-INVASIVE HEART-SURGERY - THE PRESERVATION OF MEDIAN APPROACH

Objective: Cardiac surgery has been traditionally performed via a medi an sternotomy incision where a large exposure of the mediastinum assur ed most of the cardiac procedures. Recently, the concepts of less-inva sive surgery, well affirmed in many surgical specialties, led cardiac surgeons to develop limited accesses in coronary, valves and congenita l operations. Methods: Between January and May 1997, 30 patients were operated on with a less-invasive approach. A short (6-9 cm) median inc ision followed by a subcomplete sternotomy permitted a limited opening of the chest without compromising the surgical exposure; a convention al central CPB was instituted and valve surgery and mast of intracardi ac procedures were performed without modification of the standard tech nique. Results: No mortality was observed: morbidity was minimal. Card iopulmonary bypass time and aortic cross-clamp time averaged 84 +/- 9 and 61 +/- Il min, respectively. The majority of patients were extubat ed and discharged from the ICU early. Chest drainage lost on average 2 90 +/- 180 ml/m(2). Conclusions: Despite our limited initial experienc e, this technique seems to provide several potential and practical adv antages: there is less trauma and pain reported by patients; the small wound reduces the potential for wound infection and blood loss. Patie nts are extubated and discharged front the hospital earlier with lower overall costs. (C) 1998 Elsevier Science B.V. All rights reserved.