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Lower hemisternotomy: infrequently used but versatile.

Andreas Voetsch1, Andreas Winkler1, Philipp Krombholz-Reindl1

  • 1Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria.

The Journal of Cardiovascular Surgery
|February 22, 2021
PubMed
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The lower hemisternotomy approach is a viable option for various cardiac surgeries, offering good clinical outcomes. This minimally invasive technique allows direct visualization of heart structures, making it a valuable alternative.

Area of Science:

  • Cardiac Surgery
  • Minimally Invasive Procedures
  • Thoracic Surgery

Background:

  • Lower hemisternotomy is an underutilized approach in cardiac surgery.
  • This study evaluates the applicability and outcomes of cardiac procedures performed via lower hemisternotomy.

Purpose of the Study:

  • To assess the clinical outcomes and applicability of the lower hemisternotomy approach.
  • To determine the safety and efficacy of this minimally invasive cardiac surgery technique.

Main Methods:

  • Retrospective review of 55 consecutive patients undergoing minimally invasive cardiac procedures via lower hemisternotomy from 2014-2019.
  • Data collected included demographics, procedural details, and clinical outcomes with a median follow-up of 34 months.

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Main Results:

  • Procedures included mitral/tricuspid repairs, aortic valve replacement, and coronary artery bypass grafting.
  • High repair rate (97.6%) for degenerative mitral insufficiency.
  • Low reoperation rate (1.8%) for bleeding and acceptable 30-day mortality (3.6%).

Conclusions:

  • Lower hemisternotomy is a suitable minimally invasive approach for selected cardiac procedures.
  • Enables central aortic cannulation and direct visualization of intracardiac structures.
  • Should be considered as an alternative minimally invasive surgical option.