Initial Experience with Upper and Lower Mini-sternotomy for Single and Multiple Valve Heart Surgery

Mikhail Nuzhdin ¹, Anton Baranov ¹, Artem Tsarkov ², Aleksey Fokin ³, Ilya Melnikov ¹, Denis Loganenko ¹, Yury Malinovsky ¹

¹ Chelyabinsk Regional Clinical Hospital, Department of Cardiac Surgery, Chelyabinsk, Russia; ² Chelyabinsk Regional Clinical Hospital, Department of Anaesthesiology, Chelyabinsk, Russia; ³ South Ural State Medical University, Chelyabinsk, Russia;

Date, time and location: 2018.05.26 17:00, Exhibition area, 1st Floor. Zone – C

Abstract

OBJECTIVE:We present the initial results of single and concomitant aortic, mitral or even multiple valve surgery through the upper or lower mini-sternotomy.

METHODS:From September 2017 to December 2017, 14 patients with isolated aortic, mitral and combined valve disease underwent valve replacement or repair by means of upper (10 cases) or lower (4 cases) ministernotomy. Multi-spiral contrast-enhanced CT scan was done to enroll patients for upper or lower incision. A six centimeter skin incision and partial sternotomy with extension to the third right intercostal space was performed. Central cannulation of both aorta and vena cava was utilized in all cases, depended on the type of sternotomy. Arresting of the heart was provided by a single dose of antegrade crystalloid (12 cases) or cold blood cardioplegia (2 cases).

RESULTS:The access to the aortic and mitral valves was standard in cases of lower mini-sternotomy. The access to the mitral valve in case of upper ministernotomy was achieved through the left atrium roof. A LV vent was inserted directly into the aortic root. Removing of valves, placing the stitches and prosthesis insertion was standard without any device. The aortotomy and atriotomy were closed in two layers and the chest closed in a standard fashion. There were 4 cases of isolated aortic valve replacement, 1 case of mitral and tricuspid valve repair, 1 case – mitral valve replacement, 8 cases of double valve replacement. The postoperative course was uneventful in all cases.

CONCLUSION:According to our initial results, both single and multiple valve surgery can be safely performed via a upper or lower mini-sternotomy. Preoperative CT scan is a very useful and essential option for surgical strategy. Sufficient exposure without femoral cannulation and any special devices can be achieved with upper or lower mini-sternotomy.