Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2013 Nov;5 Suppl 6(Suppl 6):S662-8.
doi: 10.3978/j.issn.2072-1439.2013.10.02.

Aortic valve replacement through J-shaped partial upper sternotomy

Shahzad G Raja  1 , Umberto Benedetto, Mohamed Amrani
Affiliations
Review

Aortic valve replacement through J-shaped partial upper sternotomy

Shahzad G Raja et al. J Thorac Dis. 2013 Nov.

Abstract

The introduction of minimally invasive techniques in general surgery, in the late 1980s, influenced cardiac surgery as well. This led to the emergence of several minimal access approaches for aortic valve replacement (AVR). Currently, the upper partial sternotomy with unilateral J-shaped extension to the right through the fourth intercostal space is the most popular minimal access approach. This approach offers the comfort factor of sternotomy, improved cosmetic result, preserved respiratory mechanics, and last but not the least cost saving as no new equipment is required. On the other hand, inability to visualize the whole heart, adequately de-air the left heart, and failure to apply epicardial pacing wires are some of the perceived disadvantages of this approach. This article provides a comprehensive review of the indications, contraindications, technical aspects, outcomes, advantages and disadvantages of AVR through J-shaped partial upper sternotomy.

Keywords: Aortic valve replacement (AVR); J-shaped limited sternotomy; minimal access surgery; minimally invasive surgery; partial upper sternotomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Skin incision for partial sternotomy; (B) Finocchietto retractor separating sternal edges with pericardial stay sutures in place; (C) Cardioplegia cannula and cross clamp demonstrated; (D) Aortotomy and aortic valve excision demonstrated.
Figure 2
Figure 2
Kaplan-Meier analysis for late survival in patients undergoing ministernotomy versus full sternotomy AVR.
See this image and copyright information in PMC

References

    1. Cosgrove DM, 3rd, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 1996;62:596-7 - PubMed
    1. Benetti FJ, Mariani MA, Rizzardi JL, et al. Minimally invasive aortic valve replacement. J Thorac Cardiovasc Surg 1997;113:806-7 - PubMed
    1. Gundry SR, Shattuck OH, Razzouk AJ, et al. Facile minimally invasive cardiac surgery via ministernotomy. Ann Thorac Surg 1998;65:1100-4 - PubMed
    1. Bridgewater B, Steyn RS, Ray S, et al. Minimally invasive aortic valve replacement through a transverse sternotomy: a word of caution. Heart 1998;79:605-7 - PMC - PubMed
    1. Kim BS, Soltesz EG, Cohn LH. Minimally invasive approaches to aortic valve surgery: Brigham experience. Semin Thorac Cardiovasc Surg 2006;18:148-53 - PubMed