Aortic and mitral valve replacement through a minimally invasive approach

Less invasive approaches to cardiovascular surgery are used increasingly to reduce surgical trauma and shorten hospital stay. The rarely used upper partial sternotomy and parasternal incision can confer the advantages of a smaller surgical wound: reduced blood loss, decreased risk of infection, shorter intubation, earlier discharge, decreased postoperative pain, and a smaller, cosmetically more acceptable postoperative scar. Moreover, reoperation is less hazardous, because the pericardium was not completely dissected. From the beginning of December 1996 to the end of January 1998, a minimally invasive approach was used for aortic valve replacement in 10 patients, and for mitral valve replacement in 2 patients. Patients with coronary artery disease, aneurysm of the ascending aorta, and poor ejection fraction were excluded from the group, but diabetes mellitus, obesity, and impaired pulmonary function were not considered contraindications to the operation. No patients required conversion to full sternotomy or reoperation. There were no wound infections, neurological deficits, or fatalities. The technique has proved safe, effective, and aesthetically acceptable to the patient.