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Ann Thorac Surg 2007;84:1053-1055
© 2007 The Society of Thoracic Surgeons

How To Do It

Partial Median "I" Sternotomy: Minimally Invasive Alternate Approach for Aortic Valve Replacement

Johannes Boehm, MDa, Paul Libera, MDa, Albrecht Will, MDb, Stefan Martinoff, MDb, Stephen M. Wildhirt, MD, PhDa,*

a Department of Cardiothoracic Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
b Institute for Radiology, German Heart Center Munich, Technical University of Munich, Munich, Germany

Accepted for publication December 21, 2006.

* Address correspondence to Dr Wildhirt, Department of Cardiothoracic Surgery, German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, Munich, D-80636, Germany (Email: wildhirt{at}gmx.net).

Minimally invasive aortic valve replacement using the inversed L-like partial upper sternotomy has evolved during the last 10 years. It is performed with excellent results with regard to sternal stability and cosmesis. However, the lateral incision may result in sternal overriding, instability, or fracture. We present an alternate minimally invasive approach to aortic valve replacement. We performed a partial median "I" sternotomy in 30 consecutive patients: After a 6- to 8-cm skin incision, the sternum was incised from the jugulum downward to the corpus, ending at the level of the fourth or fifth intercostal space. No lateral incision of the sternum was performed. The access to the heart and aorta was excellent. During the postoperative course and during follow-up, clinical examination revealed sternal stability and normal wound healing in all patients. These results show that the partial median I sternotomy can be performed safely and provides excellent clinical and cosmetic results.






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