title: A cosmetic access for minimally invasive aortic valve replacement without sternotomy in women.
abstract: BACKGROUND
  Different methods of replacing the aortic valve via a minimally invasive access have been reported in the recent literature. Although these strategies have clear advantages in terms of reduced surgical trauma, no further refinements in terms of cosmetic results have been made for women.
  
  
  METHODS
  Aortic valve replacement was performed in 4 women via a right anterior submammary minithoracotomy without rib resection. The incision was made along the breast fold. The extracorporeal circulation was connected through the same access. Standard surgical technique and equipment were employed.
  
  
  RESULTS
  No intraoperative complications or hospital deaths occurred. The 4 patients could be discharged home on the sixth postoperative day. The cosmetic result was excellent and the wound completely disappeared within the breast fold.
  
  
  CONCLUSIONS
  The advantages of the present method include the preservation of sternal integrity, early mobilization and rehabilitation and an excellent cosmetic result for women.
authors.affiliation: Heart Department, Division of Cardiovascular Surgery, San Carlo Hospital, Potenza, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Minale
authors.forename: Biagio
authors.initials: B
authors.lastname: Tomasco
authors.forename: Maurilio
authors.initials: M
authors.lastname: Di Natale
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012720:Severity of Illness Index; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome