title: Traction suture modification of the Cosgrove hemisternotomy technique.
abstract: OBJECTIVE
  Minimal access is an integral part of cardiac surgery. A personal customization is presented of the Cosgrove technique of hemisternotomy for aortic valve surgery.
  
  
  METHODS
  The procedure involves an additional 2 cm right anterior intercostal incision, through which a Roberts clamp is used to tension a suture from the right pericardial flap, thus optimizing exposure of the right atrium. The incision is used later to insert a pericardial drain.
  
  
  RESULTS
  The modified Cosgrove technique was applied to 66 patients (43 men, 23 women; mean age 60.47 years; median age 64 years; range: 29-85 years) between January 2005 and March 2010. During the postoperative period, no conversion, tamponade or fatality has been observed among patients.
  
  
  CONCLUSIONS
  This traction suture represents a simple and safe means of optimizing exposure of the right atrium, which is problematic in this type of operation.
authors.affiliation: Harefield Hospital, Middlesex, United Kingdom. Aristotelis.Protopapas02@Imperial.ac.uk
authors.forename: Aristotle D
authors.initials: AD
authors.lastname: Protopapas
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D003250:Constriction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques / Q000009:adverse effects; D014143:Traction / Q000009:adverse effects; D016896:Treatment Outcome