Improvement of aortic exposure by superior vena cava snaring and traction during lower partial sternotomy

A midline lower partial sternotomy without any lateral cuts gives good exposure to all structures of the heart but exposure of the aortic valve may be difficult. The aim of this study was to determine the impact of snaring and traction of superior vena cava (SVC) during lower hemisternotomy for aortic valve surgeries on surgical visibility. A prospective study was carried out requiring the measurement of degree of movement of the aorta anteriorly before and after snaring and traction of SVC. All adult patients requiring aortic valve surgeries and other valve surgeries along with aortic valve surgeries were included. Aortic valve surgeries requiring transection of aorta and redo surgeries were excluded. A total of 71 patients were studied. We found that after snaring and traction of the SVC, the mean depth of the aorta from the outer table of sternum reduced by 2.45 cm and the mean angle of the aorta with the right ventricular outflow tract (RVOT) was increased by 9.11°. In our study, we concluded that, when the SVC is snared and given traction towards the right shoulder of the patient, it brings the aorta anteriorly and makes the aorta more upright allowing better exposure.