J Thorac Cardiovasc Surg 1998;115:256-257
© 1998 Mosby, Inc.
Partial sternotomy for cardiac operations
G. Walterbusch, Prof.Dr.Med.
To the Editor:
A mini-T sternotomy for routine cardiac operations was recently described by Moreno-Cabral
1 in this Journal. As in the author's experience, it was a patient with a permanent tracheostomy for whom my colleagues and I developed a similar approach. After observing a sufficient exposure of the heart for complete myocardial revascularization, we used this approach with increasing frequency, and it has now become a routine approach for all types of cardiac operations except for aortic aneurysms and redo procedures.
Our experience includes 371 coronary artery bypass procedures, 30 aortic valve replacements, five mitral valve replacements, five closures of atrial septal defects and postinfarction ventricular septal defects, two resections of atrial myxomas, and eight combined operations. At the last annual meeting of the German Society of Thoracic and Cardiovascular Surgery, we 2 compared the first 150 such coronary bypass operations to 150 cases done by the same surgeon previously by means of a complete sternotomy. There was no statistically significant difference in operative mortality, sternal wound infection, and perioperative blood loss. The only difference was a slightly prolonged operating time of 9 ± 3 minutes in the ministernotomy group. This is thought to be due to the smaller operative field in the latter in comparison with the more luxurious approach of the standard sternotomy. Thin and tall patients could be operated on with the same ease as in standard sternotomy, whereas the approach to the heart was less convenient in small and obese patients.
In comparison with Moreno-Cabral's variant, our ministernotomy differs in two details that are worth mentioning. We divide the manubrium from the corpus in an inverted V-shaped line, which allows aortic cannulation near the pericardial fold, thereby obviating a special retractor for the manubrium. The inverted V-shaped incision also prevents horizontal dislocation of the sternal coaptation. We always cut the xiphoid process completely off the sternum, which helps keep the skin incision as short as possible (Figs. 1 and 2). Reduced postoperative discomfort and faster recovery were difficult to prove in our patients. The most striking difference was the cosmetic result, however, with a reduction of the incision to nearly half the size used in conventional sternotomy. This was reason enough for most patients to request the ministernotomy.
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Fig. 1. In partial sternotomy, only the corpus is divided longitudinally. Transection of the manubrium follows an inverted V-shaped line. The xiphoid is simply cut off with bone scissors.
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References
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Moreno-Cabral RJ. Mini-T sternotomy for cardiac operations. J Thorac Cardiovasc Surg 1997;113:810-1.[Free Full Text]
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Walterbusch G, Jung V, Rudke M. Partial median sternotomy for complete myocardial revascularization. Thorac Cardiovasc Surg 1997;180(Suppl 45):Abstract 147.
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