Manubrium-sparing median sternotomy - as a uniform approach for cardiac operations

We used a manubrium-sparing sternotomy to perform intracardiac operations o n 26 patients between November 1997 and April 1998. We developed this less- invasive surgical technique as a uniform approach in order to reduce skin a nd skeletal trauma, while maintaining the advantages of the full median ste rnotomy, such as standard aortic and venous cannulations and use of both an tegrade and retrograde cardioplegia. During the same period, 26 other patie nts with intracardiac lesions underwent operation through a standard full s ternotomy. in the manubrium-sparing sternotomy group, there was no intraope rative complication or conversion to full median sternotomy. The average po stoperative chest drainage was less in the manubrium-sparing sternotomy gro up (242.7 +/- 184.5 mL/24 hours, vs 499.2 +/- 416.3 mL/24 hours; P < 0.01). Two patients (7.7%) in the manubrium-sparing sternotomy group had superfic ial wound disruption, but 4 patients (15.4%) in the full sternotomy group h ad more severe wound infection, and 1 required myoplasty because of deep wo und infection. During the mean follow-up period (12.4 +/- 1.9 months), no p atient in the manubrium-sparing sternotomy group reported significant disco mfort or pain due to the sternotomy, but 6 patients (23.1%) in the full ste rnotomy group complained of significant sternal pain, while 4 (15.4%) exper ienced shoulder pain, and 1 (3.8%) experienced numbness of the 4th and 5th fingers of both hands. We conclude that the manubrium-sparing sternotomy is a safe and useful approach for most cardiac operations. It is effective in reducing surgical trauma and postoperative wound discomfort.