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J Thorac Cardiovasc Surg 1998;115:1390-1391
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Minimal-access redo aortic valve replacement

R. K. W. Tam, FRACS

Reply to the Editor:

My colleagues and I thank Morishita and his associates for their interest in our report on minimally invasive redo aortic valve replacement (AVR). In any new surgical procedure, safety rather than cosmetic appearance is the major priority. Since our publications, we have used this approach in 47 cardiac operations: 24 primary AVRs, 4 redo AVRs, 14 mitral valve operations, 2 double valve replacements, 2 excisions of atrial tumors, and 1 removal of an infected pacing wire.

With experience, our skin incision is made 2 to 3 cm below the sternal notch and extends distally for 8 to 10 cm. Therefore the cosmetic appearance is not different from that of a parasternal, mini-T, or J sternotomy.Go Go 1-3 With regard to a transverse incision, we have found that the exposure of the whole aorta is inadequate and may necessitate femoral cannulation. Sacrificing both of the internal thoracic arteries is a high price to pay, particularly in young patients.

I share similar concerns with Morishita and associates regarding scarring, particularly in Asian patients who heal with keloid formation. In our experience with full sternotomy, it is the lower part of the wound that tends to heal with keloid formation. The upper part of the sternotomy wound heals beautifully with a hairline scar.

I agree with Morishita and coworkers that the right atrial appendage can be easily cannulated, as we have observed in other redo operations.

Department of Cardiac SurgeryThe Prince Charles HospitalRode Rd., Chermside, Brisbane Q 4032, Australia12/8/89289

References

  1. Navia JL, Cosgrove DM III. Minimally invasive mitral valve operations. Ann Thorac Surg 1996;62:1542-4.[Abstract/Free Full Text]
  2. Svensson LG. Minimal-access "J" or "j" sternotomy for valvular, aortic, and coronary operations or reoperations. Ann Thorac Surg 1997:64:1501-3.
  3. Moreno-Cabral RJ, Mini-T sternotomy for cardiac operations. J. Thorac Cardiovasc Surg 1997;113:810-1.[Free Full Text]




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