Less-invasive heart surgery: the preservation of median approach

OBJECTIVE: Cardiac surgery has been traditionally performed via a median sternotomy incision where a large exposure of the mediastinum assured most of the cardiac procedures. Recently, the concepts of less-invasive surgery, well affirmed in many surgical specialties, led cardiac surgeons to develop limited accesses in coronary, valves and congenital operations. METHODS: Between January and May 1997, 30 patients were operated on with a less-invasive approach. A short (6-9 cm) median incision followed by a subcomplete sternotomy permitted a limited opening of the chest without compromising the surgical exposure; a conventional central CPB was instituted and valve surgery and most of intracardiac procedures were performed without modification of the standard technique. RESULTS: No mortality was observed; morbidity was minimal. Cardiopulmonary bypass time and aortic cross-clamp time averaged 84+/-9 and 61+/-11 min, respectively. The majority of patients were extubated and discharged from the ICU early. Chest drainage lost on average 290+/-180 ml/m2. CONCLUSIONS: Despite our limited initial experience, this technique seems to provide several potential and practical advantages: there is less trauma and pain reported by patients; the small wound reduces the potential for wound infection and blood loss. Patients are extubated and discharged from the hospital earlier with lower overall costs.