S-shaped in comparison to L-shaped partial sternotomy for less invasive aortic valve replacement.
OBJECTIVE
Evaluation of less invasive aortic valve replacement to minimize surgical trauma and achieve a better postoperative quality of life.


METHODS
Thirty-three patients had aortic valve replacement using a 4-6 cm small incision and partial sternotomy only. Partial sternotomy was performed proximal (16), S-shaped (14) or horizontal (3). Access for cardiopulmonary bypass was via sternotomy (24) or the right femoral vessels (9). Patient age was 58+/-13 years, 21 had aortic stenosis and 12 aortic incompetence.


RESULTS
Surgical exposure was sufficient and allowed for uncomplicated AVR in all patients. Mechanical valves (20), conventional bioprostheses (3), stentless bioprostheses (9) or a homograft (1) were implanted. Crossclamp time was not prolonged in comparison to the conventional technique. Intensive care stay and hospital stay were 1 and 10 days, respectively. One patient had to be reoperated for paravalvular leakage, two patients (horizontal sternotomy) had sternal dehiscence. Postoperative pain was low in most patients.


CONCLUSIONS
Less invasive aortic valve replacement is feasible with good functional results. The S-shaped sternotomy approach is advantageous whereas the horizontal sternotomy is no longer performed due to a high rate of instability. This new technique will be further evaluated in comparison to the conventional approach.
Autschbach
R
R
Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Germany.
Walther
T
T
Falk
V
V
Diegeler
A
A
Metz
S
S
Mohr
F W
FW
D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D013249:Sternum / Q000601:surgery*; D013997:Time Factors