Minimath mvasive curdiac surgerv has been developed to offer pauents the benefitsal’open heart operationas with decrreascd pain and limited skin incision A limitedsuperior median sternotomy has been shown to provide a good exposure for aorticvalve replacement(AVR:and good results In this study we report the results ofminimaly AVR compared standard sternotomy AVR performed in the same period.I rom Muv 1996 to January 1998.86 patients received isolated aortic valvereplacement by the hmited stiperior median sternotom(group 1).As a control groupreplacement by standard sternotomy in the same period.Surgical procedure.A midline skin mcision from the first to the first to the third intercostalspace and a median stemolomy from jugular notch to the fourth intercostal space areperformed.The pericardium is incised.eposing the ascending sorta and rightatrium Aortic and right atrial cannulation are performed as usual Cardiopulmonarybypass and cardioplegia are applied by the usual technique.After opening the aorta.three traction sutures at the tip of the commissures ate placed elevating the valvefor better exposure.After being weaned from cardiopulmonary bypass,oneretrosternal tube is placed and the sternotomy is closed with one metal band and twoMedian ischemic time and median bypass time between the two groups showed nosignificant difference(p0.05)Median entire operation time in group I wasobviously shorter than that in group 2(p0.01).Median postoperative dramagewas 229ml in group one.369ml in group 2.The difference between the two groups(p0.05)was significant.Median postoperative respiratory support time was 743hours(h)in group one.11.26h in group 2.with signifieant difference(p0.05).Median duration of hospital stay were 6.2 days(d)in group 1.94d in group 2.withsignificant difference(p0.01).Reoperntions for bleeding were 2 in group 1.4 ingroup 2.sternum infection or disruption one in group 1 and 3 in group 2 There weretwo hospital deaths respeclively in the two group(not procedure related,The limited superior median sternotomy provides good exposure to the leftventricular outflow tract aortie valve aseending norta.and even to the mitral valvethrough the roof of the left atrium Therefore it seems to be suitable for all kinds ofaortic valve operations Besides less pain.shorter skin incision.shorter respiratorysupport time and lower blood loss.it has more advantages as opening and elosure ofthe sternum is fuster.decreasing infection and disruption of the sternum.and linallydecreasing the time required for hospitah/ation and recovery.
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