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The Journal of Cardiovascular Surgery 2021 Feb 22

DOI: 10.23736/S0021-9509.21.11670-2


language: English

Lower hemisternotomy: infrequently used but versatile

Andreas VOETSCH 1, Andreas WINKLER 1, Philipp KROMBHOLZ-REINDL 1, Matthias NEUNER 2, Michael KIRNBAUER 2, Rainald SEITELBERGER 1, Roman GOTTARDI 1, 3

1 Department of Cardiovascular and Endovascular Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria; 2 Department of Anesthesia and Intensive Care, Paracelsus Private Medical University Salzburg, Salzburg, Austria; 3 Department of Cardiac, Thoracic and Vascular Surgery, Mediclin Heart Insitute Lahr/Baden, Lahr, Germany


BACKGROUND: A lower hemisternotomy is an infrequently used approach in cardiac surgery. This single center report evaluates applicability and clinical outcomes of procedures performed through a lower hemisternotomy.
METHODS: The institutional database was reviewed. From 2014 to 2019, 55 consecutive patients had undergone minimally invasive procedures through a lower hemisternotomy (median follow-up 34 months). Demographic as well as outcome data were retrieved from our prospectively maintained institutional database.
RESULTS: Performed procedures included mitral and tricuspid repairs, aortic valve replacement as well as coronary artery bypass grafting. The median patient age was 72 years. Out of the 55 patients, 55% were male. Predominantly mitral valve procedures (11 isolated, 30 combined) had been performed. Mitral valve procedures (n=41) consisted of 36 repairs and 5 replacements. Repair rate for degenerative mitral insufficiency was 97.6%. Median EuroScore II was 3.4 % [2.1-6.0]. Median cross-clamp time was 67 [44-99] min. Median procedural length was 169 [138-201] min. Reoperation rate for bleeding was 1.8%. Major vascular complications occurred in two patients. Freedom from valve related reoperation was 96.1% during follow-up. 30-day mortality and overall mortality during follow-up was 3.6% and 10.9%.
CONCLUSIONS: In properly selected cases the lower hemisternotomy allows for a variety of cardiac procedures. It permits central aortic cannulation and a direct vision of intracardiac structures and therefore should be kept in mind as an alternative minimally invasive approach.

KEY WORDS: Heart valve; Minimally invasive surgical procedures; Sternotomy

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