Minimally invasive cardiac surgery through a median sternotomy: Surgical technique and clinical experience

Background: Less invasive approaches to cardiac surgery are being popularized and a number of various techniques have been proposed without a supported clinical experience. Since the beginning of 1997, we developed routinely a minimal approach to intra-cardiac operations through a modified median sternotomy. A 6-8 cm median skin incision followed by a sub-complete median sternotomy (manubrium and body) mades opening and closing the chest easier; a conventional central CPB were instituted and no modifications to the surgical techniques were necessary. Methods: In 100 consecutive patients (mean age 62.04; range 9 to 92), 70 Aortic, 13 mitral and 17 others cardiac procedures were performed. Surgical technique required many self made instruments; anesthetic "fast-tracking" management was performed. Results: 4 patients died, 1 conversion to standard sternotomy and 5 reoperations for bleeding were necessary. Cross-clamp time ranged from 33 to 140 min (mean 69.23 +/- 20.99min) and total drainage loss from 120 ml to 1800 ml/m(2)/24 h (mean 288 ml/m(2)/24 h). The post-operative course was shorter than usual and one complication in the healing wound was observed. The scar was in all patients shorter than 9 cm. Conclusions: Our work shows that a less invasive approach to many cardiac operations is possible through a modified median sternotomy and this technique provides many potential and practical advantages: there is less trauma and pain reported by patients; the small wound reduces the risk of infection and blood loss. Patients are extubated and discharged from the hospital earlier.