Minimally invasive aortic valve replacement surgery through lower half sternotomy

Abstract

Less invasive approaches to aortic valve surgery frequently rely upon the development of new technology and instrumentation. While not suitable for every patient requiring an aortic valve procedure, these less invasive operations can offer certain clinical benefits and are becoming an important part of the modern cardiothoracic surgeon's skillset. A lower partial sternotomy approach provides excellent visualization of the operative field, efficient execution of the operation and many of the benefits of minimally invasive surgery. Importantly, the lower partial sternotomy requires no new or unusual instruments and presents a familiar view to the surgeon. The technique, therefore, lends itself well to being adapted and utilized quickly with a potentially shorter "learning curve" for maximal surgical flexibility and patient benefit.

Keywords: Aortic valve replacement; lower partial sternotomy; minimally invasive surgery.

Figure 1

A vertical incision is placed at the third interspace and extended inferiorly. The pectoralis and intercostal muscles are elevated from the sternum and the sternum is divided transversely then vertically directed inferiorly. Adapted from “Full-spectrum cardiac surgery through a minimal incision: mini-sternotomy (lower half) technique.” by Doty et al., 1998, The Annals of Thoracic Surgery, 65:573-577, Copyright 1998 by The Society of Thoracic Surgeons.

Figure 2

The sternal edges are retracted laterally and the intact upper sternum is elevated using a modified Favaloro retractor. The aortic cross-clamp is brought into the field through a separate stab incision. Adapted from “Full-spectrum cardiac surgery through a minimal incision: mini-sternotomy (lower half) technique.” by Doty et al., 1998, The Annals of Thoracic Surgery, 65:573-577, Copyright 1998 by The Society of Thoracic Surgeons.