title: Evaluation of Aortic Valve Replacement via the Right Parasternal Approach without Rib Removal.
abstract: BACKGROUND
  Although right parasternal approach (RPA) decreases the incidence of mediastinal infection, this approach is associated with lung hernia and flail chest. Our RPA employs thoracotomy with bending rib cartilages and wound closure performed by repositioning the ribs with underlying sheet reinforcement.
  
  
  METHODS
  We evaluated 16 patients who underwent aortic valve replacement via the RPA from January 2010 to August 2013. We compared outcomes of 15 male patients had the RPA with 30 male patients had full median sternotomy.
  
  
  RESULTS
  One patient with a history of radical breast cancer treatment underwent RPA with concomitant right coronary artery bypass grafting. No hospital deaths occurred. Four patients developed hospital-associated morbidity (re-exploration for bleeding, prolonged ventilation, cardiac tamponade, and perioperative myocardial infarction). There were no conversions to full median sternotomy, mediastinal infections, and lung hernias. Preoperative computed tomography showed that the distance from the right sternal border to the aortic root was significantly associated with operation times. With RPA, there was no significant difference in outcomes, despite significantly longer operation times compared with full median sternotomy.
  
  
  CONCLUSIONS
  Our RPA provides satisfactory outcomes without lung hernia, especially in patients unsuitable for sternotomy. Preoperative computed tomography is useful for identifying appropriate candidates for the RPA.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan.
authors.forename: Akimasa
authors.initials: A
authors.lastname: Morisaki
authors.forename: Koji
authors.initials: K
authors.lastname: Hattori
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.forename: Manabu
authors.initials: M
authors.lastname: Motoki
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nishimura
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D061646:Operative Time; D010027:Osteotomy / Q000009:adverse effects; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome