Less invasive aortic valve surgery: rationale and technique

The unquestionable aims for a less invasive operations are less morbidity, less discomfort, and a reduced hospital stay through an operation which pro ves equally durable to the conventional approach. Such an operation must be carried out without further risk to the patient or increased difficulty fo r the surgeon. Whilst most definitions of less invasive coronary surgery in clude the phrase without cardiopulmonary bypass, this is clearly not yet po ssible in valve surgery. In valve surgery, the definition of less invasive relates only to the size of incision and rate of recovery. As a result of t he discussions during the Heart Lab International Workshop on video-assiste d heart surgery in Zurich, October 22-25, 1998, the following conclusions e merged. The partial upper sternotomy with J- or L-shaped extension to the r ight is the preferred approach for minimally invasive aortic valve surgery. Other methods which sacrify the internal thoracic arteries, open pleural c avities or predispose to long hernia are less satisfactory. A detailed desc ription of the technique proposed is given and its indications and contrain dications are discussed. (C) 1999 Elsevier Science B.V. All rights reserved .