Subtotal median sternotomy for heart surgery

Objective: Many approaches for minimally invasive heart surgery are availab le. Although they have many advantages, inadequate exposure, mammary artery injury and special tool requirements are known problems. Subtotal median s ternotomy (SMS) was developed to overcome such limitations. Comparing the S MS with the standard sternotomy (SS) is the purpose of this study. Methods: SMS was used in 210 patients (group I) requiring coronary artery bypass gr afting and or valvular surgery. This was compared with another 210 patients (group II) in which SS was used. The technical difficulties, incisional di scomfort, wound infection, patient satisfaction and hospital stay are the c omparison criteria. Results: (1) SMS takes an average of 24 min longer, P < 0.15. (2) Incisional discomfort graded (I 'least' to III 'greatest'), grou p I: (27 Grade I, 176 Grade II, seven Grade III). Group II: (21 Grade I, 18 3 Grade II, six Grade III), P < 0.1. (3) Wound infection: two superficial, two deep in group I: four superficial and one deep in group II, P ( 0.06, ( 4) 99% satisfaction and 5.4 days mean hospital stay in group I, 63% and 7.1 days in group II, P ( 0.01 and ( 0.03, respectively. Conclusion: When comp aring the SMS technique with the SS: (1) SMS has statistically significant better patient satisfaction; (2) can be very cost effective due to the shor t hospital stay and the absence of a need for special instruments. (C) 2000 Elsevier Science B.V. All rights reserved.