Modified parasternal approach is a good alternative for aortic valve surgery

Abstract

Aim: Cardiac surgery, as with other surgical specialties, has moved toward minimally invasive procedures. Currently, since the cardiopulmonary bypass machine remains necessary for most cardiac surgery procedures, efforts have focused on decreasing surgical trauma by limiting vascular access sites and any unnecessary dissection. This study presents the authors’ approach for less invasive valve surgery, which aimed to avoid a conventional midline sternotomy and reducing the length of incision.

Methods: For patients with aortic valve involvement, parasternal approach was the primary choice. A longitudinal 5-6 cm incision was made one fingerbreadth lateral to the sternal border. The 3rd rib was cut at the chondrosternal junction and bent into the right pleural cavity. After either central aortic or peripheral cannulation, all procedures were completed under surgeon’s direct vision and conventional instruments. The rib was reduced into position with a wire to offer stability and eliminate postoperative chest deformity.

Results: The authors’ experience of more than 500 cases with the minimally invasive approach showed that bypass time and ischemic time for parasternal valve surgery were compatible with to a full-sternotomy approach. In this series, postoperative ventilation time, blood product consumption and overall mortality were reduced.

Conclusion: Reviewing the parasternal aortic valve series of more than 500 cases, parasternal approach is safe, effective, and reproducible. The surgical trauma and blood product consumption were minimized with this approach. Multiple valve procedures and ablation for atrial fibrillation are also feasible. Stable sternoclavicular joints could facilitate early and aggressive activity of upper extremities for improved postoperative recovery. This approach could be a good alternative option in aortic or multiple valve surgical procedures.

Keywords

Parasternal approach / aortic valve surgery / modified parasternal incision / sternum-sparing aortic valve surgery / minimally invasive aortic valve surgery

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