Minimal access aortic valve replacement via limited skin incision and complete median sternotomy

Abstract

Surgical aortic valve replacement (AVR) via complete median sternotomy is a safe and time-tested technique associated with excellent short- and long-term outcome. Over the last two decades, different minimally-invasive approaches for AVR have been developed and are increasingly being utilized. All these approaches have been developed with the main objective of decreased invasiveness and less surgical trauma. Advantages of minimal invasive AVR have been shown as better cosmesis, shorter ventilation time, decreased blood loss, shorter intensive care unit and hospital length of stay, and less postoperative pain with mortality and morbidity comparable to conventional complete median sternotomy. One well-recognized but less practiced surgical technique for surgical AVR is the complete median sternotomy via limited skin incision. This review article provides a detailed insight into the technical aspects, outcomes, advantages and disadvantages associated with minimal access AVR via limited skin incision and complete median sternotomy.

Keywords: Aortic valve replacement (AVR); limited skin incision; median sternotomy; minimal access surgery; minimally invasive surgery.

Figure 1

Technical aspects. (A) A midline skin incision is started 2 cm below the level of the sternal angle of Louis and extended to a maximum of 3 inches; (B) A complete median sternotomy is performed using a pendulum saw; (C) A Finocchietto retractor is inserted and the pericardium is opened through a vertical incision followed by traction sutures to expose the ascending aorta and the right atrial appendage; (D) Aortic and right atrial cannulation; (E) Aortic cross clamp in place with aortotomy; (F) Sutured skin incision upon completion of surgery. Figure reproduced with permission from Copyright © 2013 Alassar et al.; licensee BioMed Central Ltd.