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Ann Thorac Surg 1998;66:1050-1054
© 1998 The Society of Thoracic Surgeons

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Supplement

Less invasive cardiac operations through a median sternotomy: 100 consecutive cases

^a Department of Thoracic and Cardiovascular Surgery, University Hospital, Caen, France

Address reprint requests to Dr Massetti, Department of Thoracic and Cardiovascular Surgery, CHU "Cote de Nacre," 14033 Caen, France
e-mail: (massetti-m{at}chu-caen.fr)

Presented at "Facts and Myths of Minimally Invasive Cardiac Surgery: Current Trends in Thoracic Surgery IV," New Orleans, LA, Jan 24, 1998.

Abstract

Background. In the beginning of 1997, we developed a routine approach to intracardiac operations through a less invasive median sternotomy. A limited (6 to 9 cm) median skin incision followed by a subcomplete (manubrium and body) median sternotomy makes opening and closing of the chest easier; conventional central cardiopulmonary bypass is instituted, and no modifications to the surgical techniques are necessary.

Methods. In 100 consecutive patients (mean age, 62.04 years; range, 9 to 92 years), 70 aortic, 13 mitral, and 17 other cardiac procedures were performed. Surgical technique required many self-made instruments; anesthetic "fast-tracking" management was performed.

Results. Four patients died. One conversion to a standard sternotomy and five reoperations for bleeding were necessary. Cross-clamp time ranged from 33 to 140 minutes (mean ± standard deviation, 69.23 ± 20.99 minutes) and total drainage loss ranged from 120 to 1,800 mL · m^-2 · 24 h^-1 (mean, 288 mL · m^-2 · 24 h^-1). The postoperative course was shorter than usual, and one complication in the healing wound was observed. The scar was shorter than 9 cm in all patients.

Conclusions. Our work shows that a less invasive approach to many cardiac operations is possible through a modified median sternotomy. This technique provides many potential and practical advantages: there is less trauma and pain reported by patients, and the small wound reduces the risk of infection and blood loss. Patients are extubated and discharged from the hospital earlier.

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