Usefulness of Lower Ministernotomy in Aortic Valve Replacement (AVR) by Minimary Invasive Cardiac Surgery (MICS)

(Department of Cardiovascular and Thoracic Surgery, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya, Japan)

Souichi Shioguchi Yoshihito Irie Nobuaki Kaki
Masahito Saito Shuichi Okada Koyu Tanaka
Takao Imazeki
Upper ministernotomy is frequently selected in aortic valve replacement by minimary invasive cardiac surgery. However, retrograde cardioplegia cannulae cannot be inserted to some sites. CT examinations in our department revealed that lower ministernotomy can be used for surgery of the aortic valve in many Japanese cases. The usefulness of 2 approaches was examined in 68 cases with aortic valve disease who received aortic valve replacement by minimary invasive cardiac surgery from January 1997 to March 2002: Those who received upper ministernotomy (U group) and those who received lower ministernotomy (L group). Retrograde cardioplegia is frequently used in aortic valve replacement for myocardial protection. Those in the L group showed effectiveness in myocardial protection and in securing the operation field except in cases who were switched to full sternotomy. In the L group, the MAZE operation was performed and no significant differences were observed in aortic cross-clamping time, artificial cardiorespiratory time, operation time, bleeding amount and other factors. Lower ministernotomy was more effective than upper ministernotomy in myocardial protection by retrograde cardioplegia and securing the operation field in aortic valve replacement by minimally invasive cardiac surgery.
@Jpn. J. Cardiovasc. Surg. 33: 325-328 (2004)