Evaluation of Aortic Valve Replacement via the Right Parasternal Approach without Rib Removal
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- Morisaki Akimasa
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
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- Hattori Koji
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
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- Kato Yasuyuki
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
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- Motoki Manabu
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
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- Takahashi Yosuke
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
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- Nishimura Shinsuke
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
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- Shibata Toshihiko
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan
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Background: Although right parasternal approach (RPA) decreases the incidence of mediastinal infection, this approach is associated with lung hernia and flail chest. Our RPA employs thoracotomy with bending rib cartilages and wound closure performed by repositioning the ribs with underlying sheet reinforcement. Methods: We evaluated 16 patients who underwent aortic valve replacement via the RPA from January 2010 to August 2013. We compared outcomes of 15 male patients had the RPA with 30 male patients had full median sternotomy. Results: One patient with a history of radical breast cancer treatment underwent RPA with concomitant right coronary artery bypass grafting. No hospital deaths occurred. Four patients developed hospital-associated morbidity (re-exploration for bleeding, prolonged ventilation, cardiac tamponade, and perioperative myocardial infarction). There were no conversions to full median sternotomy, mediastinal infections, and lung hernias. Preoperative computed tomography showed that the distance from the right sternal border to the aortic root was significantly associated with operation times. With RPA, there was no significant difference in outcomes, despite significantly longer operation times compared with full median sternotomy. Conclusion: Our RPA provides satisfactory outcomes without lung hernia, especially in patients unsuitable for sternotomy. Preoperative computed tomography is useful for identifying appropriate candidates for the RPA.
収録刊行物
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- Annals of Thoracic and Cardiovascular Surgery
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Annals of Thoracic and Cardiovascular Surgery 21 (2), 139-145, 2015
Annals of Thoracic and Cardiovascular Surgery 編集委員会