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Eur J Cardiothorac Surg 1999;15:781-785
© 1999 Elsevier Science NL

Review article

Less invasive aortic valve surgery: rationale and technique

^a Department for Cardio-vascular Surgery, University Hospital Vaudois, CHUV, CH-1011 Lausanne, Switzerland
^b Oxford Heart Center, Oxford, UK
^c Department for Cardio-vascular Surgery, Hospital Clinico, Barcelona, Spain
^d Service de chirurgie thoracique et cardio-vasculaire, Henri Mondor Hospital, Créteil/Paris, France
^e Institute of Anatomy, University of Zurich, Zurich, Switzerland
^f Department of Cardio-vascular Surgery, University Hospital, Zurich, Switzerland

Received 20 January 1999; received in revised form 10 March 1999; accepted 16 March 1999.

Corresponding author. Tel.: +41-21-3142280; fax: +41-21-3142279

The unquestionable aims for a less invasive operations are less morbidity, less discomfort, and a reduced hospital stay through an operation which proves equally durable to the conventional approach. Such an operation must be carried out without further risk to the patient or increased difficulty for the surgeon. Whilst most definitions of less invasive coronary surgery include the phrase without cardiopulmonary bypass, this is clearly not yet possible in valve surgery. In valve surgery, the definition of less invasive relates only to the size of incision and rate of recovery. As a result of the discussions during the Heart Lab International Workshop on video-assisted heart surgery in Zürich, October 22–25, 1998, the following conclusions emerged. The partial upper sternotomy with J- or L- shaped extension to the right is the preferred approach for minimally invasive aortic valve surgery. Other methods which sacrify the internal thoracic arteries, open pleural cavities or predispose to long hernia are less satisfactory. A detailed description of the technique proposed is given and its indications and contraindications are discussed.

Key Words: Aortic valve surgery • Less invasive surgery • Minimally invasive surgery • Limited access • Partial sternotomy

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