Ministernotomy for Aortic Valve Replacement

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.