title: Subtotal median sternotomy for heart surgery.
abstract: OBJECTIVE
  Many approaches for minimally invasive heart surgery are available. Although they have many advantages, inadequate exposure, mammary artery injury and special tool requirements are known problems. Subtotal median sternotomy (SMS) was developed to overcome such limitations. Comparing the SMS with the standard sternotomy (SS) is the purpose of this study.
  
  
  METHODS
  SMS was used in 210 patients (group I) requiring coronary artery bypass grafting and or valvular surgery. This was compared with another 210 patients (group II) in which SS was used. The technical difficulties, incisional discomfort, wound infection, patient satisfaction and hospital stay are the comparison criteria.
  
  
  RESULTS
  (1) SMS takes an average of 24 min longer, P<0.15. (2) Incisional discomfort graded (I 'least' to III 'greatest'), group I: (27 Grade I, 176 Grade II, seven Grade III). Group II: (21 Grade I, 183 Grade II, six Grade III), P<0.1. (3) Wound infection: two superficial, two deep in group I, four superficial and one deep in group II, P<0.06, (4) 99% satisfaction and 5.4 days mean hospital stay in group I, 63% and 7.1 days in group II, P<0.01 and <0.03, respectively.
  
  
  CONCLUSIONS
  When comparing the SMS technique with the SS: (1) SMS has statistically significant better patient satisfaction; (2) can be very cost effective due to the short hospital stay and the absence of a need for special instruments.
authors.affiliation: Cardiovascular Surgery Division, Maritime Heart Center, New Halifax Infirmary Hospital, Dalhousie University, Halifax, Canada. ali.i@ns.sympatico.ca
authors.forename: I M
authors.initials: IM
authors.lastname: Ali
authors.forename: S
authors.initials: S
authors.lastname: El-shanafi
authors.forename: E C
authors.initials: EC
authors.lastname: Kinley
authors.forename: V
authors.initials: V
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve; D013249:Sternum / Q000601:surgery*