Hemisternotomy approach for aortic and mitral valve surgery

After exploring several less invasive approaches for cardiac valve surgery, we have concluded that the partial upper sternotomy is the incision of cho ice for minimally invasive aortic and mitral valve surgery. From March 1997 to January 1999, 827 patients had cardiac valve surgery using this approac h; 462 had mitral valve procedures and 365 had aortic valve procedures. Of those having mitral valve surgery, 87% had mitral valve repair. Aortic valv e surgery included replacement with stented bioprostheses (38%), allografts (29%), and mechanical prostheses (10%); in addition, 23% had aortic valve repair. Operative mortality was 0.8%. Conversion to full sternotomy was nec essary in 2.4%. Blood use was low with 80% of patients receiving no blood t ransfusions. We conclude that all primary mitral and aortic procedures can be accomplished safely via partial upper sternotomy.