TITLE:
Partial Sternotomy as an Alternative Surgical Approach for Atrioventricular Valves and Atrial Septal Diseases
AUTHORS:
Henrique Madureira da Rocha Coutinho, Eduardo Haruo Saito, Gustavo Kikuta, Bernardo Ferreira Americano do Brasil, Pedro Ricardo Jazbik, Zely SantAnna Marotti Alencar, Joaquim Henrique de Souza Aguiar Coutinho, Gabriel Rodrigues Bittencourt, Rodolfo Acatauassú Nunes
KEYWORDS:
Sternotomy, Cardiovascular Surgical Procedures, Minimally Invasive Surgical Procedures
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.15 No.4,
April
10,
2025
ABSTRACT: Introduction: Since its inception, cardiovascular surgery has posed numerous technical challenges for surgeons. In a continuous quest for enhancement, cardiovascular surgeons have sought to reduce surgical trauma through the refinement of minimally invasive techniques. Therefore, this study aims to introduce a novel approach among partial sternotomies, preserving both the manubrium and xiphoid process. Our objective is to evaluate the feasibility of this surgical technique, the stability of the sternum bone in the postoperative period, the incidence of surgical wound infection, as well as the potential for patients to resume their regular activities within a 21-day timeframe. Methods: This prospective, single-center, single-arm study was conducted to assess the safety of a surgical approach involving partial sternotomy for atrioventricular valve pathologies and septal defects. A total of 18 patients were evaluated, presenting with the following: mitral insufficiency (n = 6, 30%); mitral stenosis (n = 5, 27,7%); ostium secundum-type interatrial communication (n = 3, 16,6%); sinus venosus interatrial communication, superior vena cava (n = 2, 11,1%); and myxoma (n = 2, 11,1%). Patients underwent one of the following procedures: mitral valve replacement (n = 11, 61,1%), atrial septal defect repair (n = 5, 27,7%) or atrial myxoma resection (n = 2, 11,1%). Results: One (5, 5%) patient required conversion to full median sternotomy and there were no cases of surgical wound infection. The mean length of stay was 5.4 days. Conclusion: The results found in this study show a technically feasible procedure, with no significant increase in surgical duration, and excellent outcomes regarding the absence of surgical site infection, sternal stability, and aesthetic considerations. Most patients resumed their usual activities within the proposed time. However, further extensive case studies and comparative analyses are required to validate these outcomes in comparison to conventional sternotomy procedures.