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Eur J Cardiothorac Surg 1998;14:S138-S142
© 1998 Elsevier Science NL

Less-invasive heart surgery: the preservation of median approach

Thoracic and Cardiovascular Surgery Department, University Hospital Caen, Caen, France

^* Corresponding author. Thoracic and Cardiovascular Surgery Department, CHU `Cote de Nacre' 14033 Caen, France.

Objective: Cardiac surgery has been traditionally performed via a median sternotomy incision where a large exposure of the mediastinum assured most of the cardiac procedures. Recently, the concepts of less-invasive surgery, well affirmed in many surgical specialties, led cardiac surgeons to develop limited accesses in coronary, valves and congenital operations. Methods: Between January and May 1997, 30 patients were operated on with a less-invasive approach. A short (6–9 cm) median incision followed by a subcomplete sternotomy permitted a limited opening of the chest without compromising the surgical exposure; a conventional central CPB was instituted and valve surgery and most of intracardiac procedures were performed without modification of the standard technique. Results: No mortality was observed; morbidity was minimal. Cardiopulmonary bypass time and aortic cross-clamp time averaged 84±9 and 61±11 min, respectively. The majority of patients were extubated and discharged from the ICU early. Chest drainage lost on average 290±180 ml/m². Conclusions: Despite our limited initial experience, this technique seems to provide several potential and practical advantages: there is less trauma and pain reported by patients; the small wound reduces the potential for wound infection and blood loss. Patients are extubated and discharged from the hospital earlier with lower overall costs.

Key Words: Less-invasive cardiac surgery

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