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Eur J Cardiothorac Surg 1998;14:S117-S121
© 1998 Elsevier Science NL

S-shaped in comparison to L-shaped partial sternotomy for less invasive aortic valve replacement ¹

Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Russenstrasse 19, 04289 Leipzig, Germany

^* Corresponding author. Tel.: +49 341 8651422; fax: +49 341 8651452.

Objective: Evaluation of less invasive aortic valve replacement to minimize surgical trauma and achieve a better postoperative quality of life. Methods: Thirty-three patients had aortic valve replacement using a 4–6 cm small incision and partial sternotomy only. Partial sternotomy was performed proximal (16), S-shaped (14) or horizontal (3). Access for cardiopulmonary bypass was via sternotomy (24) or the right femoral vessels (9). Patient age was 58±13 years, 21 had aortic stenosis and 12 aortic incompetence. Results: Surgical exposure was sufficient and allowed for uncomplicated AVR in all patients. Mechanical valves (20), conventional bioprostheses (3), stentless bioprostheses (9) or a homograft (1) were implanted. Crossclamp time was not prolonged in comparison to the conventional technique. Intensive care stay and hospital stay were 1 and 10 days, respectively. One patient had to be reoperated for paravalvular leakage, two patients (horizontal sternotomy) had sternal dehiscence. Postoperative pain was low in most patients. Conclusion: Less invasive aortic valve replacement is feasible with good functional results. The S-shaped sternotomy approach is advantageous whereas the horizontal sternotomy is no longer performed due to a high rate of instability. This new technique will be further evaluated in comparison to the conventional approach.

Key Words: Aortic valve replacement • S-shaped partial sternotomy • L-shaped partial sternotomy

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