[Minimally invasive cardiac surgery--the efficacy of right parasterna approach]

The recent concepts of minimally invasive surgery have affected even cardiovascular surgery. Especially, the desire to lessen incisional pain and hospital stay has made minimally invasive cardiac surgery (MICS) desirable. However, its efficacy is still controversial. To investigate this goal, we assessed the efficacy of avoidance of median sternotomy through right parasternal approach in view of the postoperative bleeding, % transfusion, postoperative intubation period, degree of incisional pain and serum level of cytokines. Patients with mitral valve disease or atrial septal defects were divided into the MICS (M) group and the control (C) group. In the M group, operations were performed through right parasternal incision under cardiopulmonary bypass (CPB) instituted by placing a venous cannula directly into superior vena cava and arterial and the other venous cannulae into femoral artery and vein. On the other hand, in the C group, operations were performed through median sternotomy under conventional CPB. There were no significant differences in CPB and AXC time between two groups. The M group showed significantly lower value in the postoperative bleeding volume, % transfusion, postoperative intubation time. Patients in the M group showed higher satisfaction of small incision as compared with those in the C group. Serum level of IL-8 after CPB was significantly lower in the M group than in the C group. These results suggested that MICS for mitral disease or ASD appears to be less invasive when median sternotomy is avoided. This suggest that MICS is a promising and contributed approach for open heart surgery to improve the QOL of the patients.