Less-invasive heart surgery: the preservation of median approach.
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.
Massetti
M
M
Thoracic and Cardiovascular Surgery Department, University Hospital Caen, France.
Babatasi
G
G
Lotti
A
A
Bhoyroo
S
S
Le Page
O
O
Khayat
A
A
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D013249:Sternum / Q000601:surgery*; D013997:Time Factors