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[Limited upper sternotomy for minimally invasive aortic valve replacement]
E Suenaga1, H Suda, Y Katayama
1Department of Cardiovascular Surgery, Nagasaki Kouseikai Hospital, Japan.
Abstract:
The practice of minimally invasive valve surgery remains controversial. From May 1998, we began minimal invasive aortic valve replacement through the limited upper sternotomy. This technique is simple and provides and easy approach for the aortic valve. From May 1998 to Jan 2000, we performed 15 cases of aortic valve replacement with the limited upper sternotomy approach. All patients received valve replacement with prosthetic valve. We also described a simple and easy air evacuation system to avoid air embolism, a serious problem with a limited operative field. Mean aortic cross clamping time was 79 min, mean cardiopulmonary bypass time was 106 min, and mean operation time was 207 min. It did not take too much time compared with the conventional approach. Mean extubation time was 62 min and mean bleeding 12 hours after the operation was 96 ml. No patient required blood transfusions. All patients but one walked the very next day after the operation. We believe this new method brings not only cosmetic benefits, but also results in excellent post-operative course.
Insights
Minimally invasive aortic valve replacement using a limited upper sternotomy offers cosmetic benefits and an excellent post-operative course. This technique provides a simple approach, avoiding complications like air embolism.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Minimally invasive valve surgery is a developing area with ongoing debate.
- Limited upper sternotomy offers a less invasive approach to the aortic valve.
Purpose of the Study:
- To evaluate the safety and efficacy of minimally invasive aortic valve replacement using a limited upper sternotomy.
- To introduce a novel air evacuation system to mitigate risks associated with limited operative fields.
Main Methods:
- A prospective study involving 15 patients undergoing aortic valve replacement via limited upper sternotomy from May 1998 to January 2000.
- All patients received prosthetic valve replacement.
- A specific air evacuation system was employed to prevent air embolism.
Main Results:
- Mean aortic cross-clamp time: 79 minutes; mean cardiopulmonary bypass time: 106 minutes; mean operation time: 207 minutes.
- Mean extubation time: 62 minutes; mean postoperative bleeding (12 hours): 96 ml.
- No patients required blood transfusions; 14 out of 15 patients ambulated the day after surgery.
Conclusions:
- Limited upper sternotomy is a viable and effective technique for aortic valve replacement.
- The described air evacuation system enhances safety in minimally invasive procedures.
- This approach provides both cosmetic advantages and a favorable postoperative recovery.