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

Abstract

We used a manubrium-sparing sternotomy to perform intracardiac operations on 26 patients between November 1997 and April 1998. We developed this less-invasive surgical technique as a uniform approach in order to reduce skin and skeletal trauma, while maintaining the advantages of the full median sternotomy, such as standard aortic and venous cannulations and use of both antegrade and retrograde cardioplegia. During the same period, 26 other patients with intracardiac lesions underwent operation through a standard full sternotomy. In the manubrium-sparing sternotomy group, there was no intraoperative complication or conversion to full median sternotomy. The average postoperative chest drainage was less in the manubrium-sparing sternotomy group (242.7+/-184.5 mL/24 hours, vs. 499.2+/-416.3 mL/24 hours; P<0.01). Two patients (77%) in the manubrium-sparing sternotomy group had superficial wound disruption, but 4 patients (15.4%) in the full sternotomy group had more severe wound infection, and 1 required myoplasty because of deep wound infection. During the mean follow-up period (12.4+/-1.9 months), no patient in the manubrium-sparing sternotomy group reported significant discomfort or pain due to the sternotomy, but 6 patients (23.1%) in the full sternotomy group complained of significant sternal pain, while 4 (15.4%) experienced 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.

Fig 1. The manubrium-sparing median sternotomy follows the dotted line from either side of the xiphoid to the first intercostal spaces. The sternum is closed with peristernal and manubrium-to-sternum wires.

Fig 2. The manubrium-sparing sternotomy is easily performed with 2 types of oscillating saws: A) a standard sternal saw for the vertical sternotomy, and B) an osteotomy saw with a 1-inch blade for the transverse osteotomy.

Fig 3. Postoperative photograph of our 1st case. This patient underwent mitral valve replacement through manubrium-sparing sternotomy. The operative scar of about 12 cm is approximately half the length of the standard sternotomy incision.