Mini-Sternotomy

Chapter

Abstract

Minimally-invasive cardiac surgery (MICS) approaches are becoming increasingly popular worldwide, with more and more minimally-invasive operations for valvular disease performed every year. MICS has steadily gained popularity among cardiac surgeons, cardiologists and patients due to the excellent clinical results, faster recovery time and more appealing cosmetic result. The main advantages reported with respect to conventional cardiac surgery are cosmesis, reduction of postoperative pain, blood loss and blood product transfusion, reduced ventilation time and pulmonary complications, shorter intensive care unit (ICU) and hospital stay, lower rehabilitation and hospital costs, and possibly better long-term outcomes [1, 2]. Techniques for MICS have continued to evolve rapidly in the last two decades with the scope of reducing wound size and chest trauma and potentiating the postoperative benefits. The rationale is that, in contrast to the traditional approach which requires the surgeon to saw open the sternum and spread the edges apart to gain direct access to the heart, a smaller incision in the upper part of the chest, dividing only the upper portion of the breastbone, will maintain the overall integrity of the rib cage and at the same time reduce the postoperative respiratory distress. Smaller incisions will bleed less and necessitate less tissue dissection, reducing the risk of wound infection. Moreover, by maintaining the integrity of the lower part of the sternum, particularly subjected to traction during coughing by the abdominal muscles that are involved, there is a reduced risk of sternal instability especially in elderly, obese, diabetic and chronic obstructive pulmonary disease (COPD) patients.

Supplementary material

Video 17.1

Ministernotomy implant of Sorin Perceval S Sutureless Bioprosthesis, by courtesy of Livanova, London. (1) From min. 0.00 to min. 2.00: ministernotomy and cannulation for CPB. (2) From min. 2.20 to min. 5.00: valve excision and decalcification. (3) From min. 5.00 to min. 5.40: valve sizing and guiding sutures placing. (4) From min. 5.40 to min. 6.40: Sorin Perceval S sutureless bioprosthesis collapsing procedure. (5) From min. 6.40 to min. 8.40: Sorin Perceval S sutureless bioprosthesis implant and intraoperative TEE control (MP4 364777 kb)

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Salus Hospital GVM Care and ResearchReggio EmiliaItaly

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