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Ministernotomy for Aortic Valve Replacement

Wednesday, September 11, 2019

Barbosa F, Moyano C, Otero A, et al.. Ministernotomy for Aortic Valve Replacement. September 2019. doi:10.25373/ctsnet.9770438.

The upper sternotomy or ministernotomy has been a well-known technique for many years, but it is not a common surgery. It has few pitfalls and not many secrets, but many benefits. Despite these factors, a minimally invasive approach is not routinely adopted. The ministernotomy finished at the third or fourth right Intercostal spaces can result in one of the pitfalls at the right mammary artery. The authors prefer to clip and section the artery. Some others prefer to respect the mammary. The point of this technique is that one must open the right pleura, and if the mammary bleeds, it can result in some blood loss. One of the tips is to put in the venous cannula as a chest tube. This can expand the operating field with less cannulae in the area, and remove the right atrium from the aortic root.


References

  1. Aris A, Cámara ML, Montiel J, Delgado LJ, Galán J, Litvan H. Ministernotomy versus median sternotomy for aortic valve replacement: a prospective, randomized study. Ann Thorac Surg. 1999; 67:1583-1587.
  2. Bonacchi M, Prifti E, Giunti G, Frati G, Sani G. Does ministernotomy improve postoperative outcome in aortic valve operation? A prospective randomized study. Ann Thorac Surg. 2002; 73:460-465.
  3. Filip G, Bryndza MA , et al. Ministernotomy or sternotomy in isolated aortic valve replacement? Early results. Kardiochir Torakochirurgia Pol. 2018 Dec;15(4):213-218.

Comments

Nice and well-documented case, congrats! As I can see is a fat woman, so reducing full sternotomy with this approach is great. I love the idea of using the same incision of the chest tube and the venous cannula. Just a couple of questions: 1. Some people believe that blood cardioplegia is the best option for several good reasons. However, other people think that this technique can be simplified with Del Nido or Bretschneider cardioplegia. Which cardioplegia do you think is better in these cases? 2. In order to improve your mediastinal visualization, It is possible to place the venous cannula through the femoral vein? Placing the wires before decanulation is clever, it could be tough to place it with the beating heart in a minimally invasive approach. Congratulations again and thank you for sharing this video.
Thanks Dr Fortunato. The first answer is that in our institution we use Del Nido Cardioplegia for the On Pump Surgeries, and for this cases, is the best one, because in 90 minutes you can perform the surgery wothout problems. The second quiestion, one of the tips of this technique is thet when you plase the venus canula like we use, it is really helpphull tp remove the right atrium form the aortic root. I have just see you Ctsnet video, https://www.ctsnet.org/article/how-perform-midcab-procedure-step-step-single-vessel-disease. Great Job, congratulations too.

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