How to Do It
Full-Spectrum Cardiac Surgery Through a Minimal Incision: Mini-Sternotomy (Lower Half) Technique

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Abstract

A technique is described in which most, if not all, cardiac operations may be performed through a standard small incision. A midline, lower half sternotomy is used. This provides traditional exposure of the heart and allows the surgeon to directly visualize the operating field and use familiar instruments. The complete spectrum of coronary revascularization and cardiac valve operations has been performed through this less-invasive incision.

Section snippets

Technique

A vertical skin incision 10 cm in length is made in the midline over the sternum extending from the third intercostal space inferiorly (Fig. 1). The pectoralis major and intercostal muscle are separated from the sternum in the third interspace to free the internal mammary vascular pedicle. The sternum is divided transversely at the third interspace and then vertically in the midline from that point inferiorly through the xiphoid process using an oscillating saw (Fig. 2). The upper half of the

Coronary Artery Bypass

After the sternum is divided, the right-angled bar on the internal mammary artery retractor is applied. The left edge of the sternum is elevated and the mammary pedicle dissection started in the third intercostal space adjacent to the transverse sternal incision. The internal mammary pedicle is developed at the lower half of the sternum. The intact portion of the sternum is elevated anteriorly using the rake retractor. This allows the mammary artery pedicle to be developed superiorly to the

Comment

New techniques for coronary artery bypass and cardiac valve surgery have been described and are being evaluated for potential reduction of perioperative morbidity and accelerated postoperative recovery. On the one hand, coronary artery bypass can be performed directly through one or more minimal incisions without cardiopulmonary bypass 1, 2, 3, and on the other hand, operations on coronary arteries and the mitral valve are performed by Port-Access (Heartport, Inc, Menlo Park, CA) techniques on

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A video clip of this procedure can be viewed on the Internet at http://www.sts.org/bio/con/annals/atseq/ 65/573/1998.

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