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Related Experiment Video

Updated: Apr 29, 2026

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Pulmonary endarterectomy through inverted-T upper hemisternotomy.

Marie De Vos1, Bart Meyns1, Rozenn Anne Quarck2

  • 1Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.

JTCVS Techniques
|December 13, 2024
PubMed
Summary
This summary is machine-generated.

The inverted-T upper hemisternotomy approach for pulmonary endarterectomy (PEA) is a feasible and safe alternative to conventional sternotomy. This minimally invasive technique yields comparable hemodynamic outcomes and reduces opioid use.

Keywords:
CTEPHhemisternotomyminimal access surgerypulmonary endarterectomy

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Minimally Invasive Procedures

Background:

  • Pulmonary endarterectomy (PEA) is a critical treatment for chronic thromboembolic pulmonary hypertension.
  • Conventional PEA typically involves a full sternotomy, which can be associated with significant morbidity.
  • Exploring less invasive surgical approaches is essential for improving patient outcomes.

Purpose of the Study:

  • To evaluate the feasibility and safety of an inverted-T upper hemisternotomy for PEA.
  • To compare perioperative and hemodynamic outcomes of this novel approach with conventional full sternotomy.

Main Methods:

  • Seventeen PEAs were performed using a 7-cm skin incision with an inverted-T upper hemisternotomy.
  • Cardiopulmonary bypass (CPB) was established using central arterial and percutaneous femoral venous cannulation.
  • Perioperative data and hemodynamic parameters were compared to 17 prior conventional PEAs.

Main Results:

  • No significant differences were observed in CPB time, deep hypothermic circulatory arrest duration, or hospital stay between the two groups.
  • Postoperative pulmonary vascular resistance showed similar improvements in both the inverted-T and conventional sternotomy groups.
  • Significantly lower intravenous opioid use was noted in the inverted-T upper hemisternotomy group (P < 1.10-4).

Conclusions:

  • The inverted-T upper hemisternotomy is a feasible and safe approach for PEA.
  • This technique achieves comparable hemodynamic results to full sternotomy without increased CPB or circulatory arrest times.
  • It offers bilateral surgical access through a single incision with limited contraindications.