"I" ministernotomy for aortic valve replacement

Background. Minimally invasive surgical approaches have been applied recent ly in the management of valvular heart disease. In this report, we reviewed our preliminary experience of minimally invasive aortic valve replacement. Methods. Eighteen patients were operated on by means of an "I" ministernoto my, and 16 patients were operated on by means of a full median sternotomy d uring the same period. There was no difference between these two groups in term of age, sex, and preoperative left ventricular ejection fraction. In p atients of the ministernotomy group, the operations were approached through an "I" median sternal split, from the second to the fifth intercostal spac e, 8 to 10 cm in length, with transverse division. Cardiopulmonary bypass w as established through aorto-right atrial cannulation with aortic cross-cla mping and antegrade or retrograde delivery of blood cardioplegia. Results. Under direct vision, aortic valve replacement was performed succes sfully in patients of both groups. The duration of cardiopulmonary bypass t ime and aortic cross-clamp time was significantly longer in the ministernot omy group than in the full sternotomy group. However, the length of incisio n, duration of endotracheal intubation, intensive care unit stay, pain scor e, postoperative length of stay, and return to normal activity interval wer e significantly shorter and lower in patients of the ministernotomy group t han in those of the full sternotomy group. All patients recovered from the operation rapidly. Follow-up was complete in all patients with no late comp lications. Echocardiographic examination showed good function of aortic pro stheses. Conclusions. Our experience demonstrates that the "I" ministernotomy provid es good exposure, reduced wound pain, enhanced recovery, shortened hospital stay, and good cosmetic healing. It may be a good alternative for surgical correction of aortic valve lesions. (C) 1999 by The Society of Thoracic Su rgeons.