Aortic Hemiarch Replacement through a J-Shaped Lower Partial Sternotomy

Abstract

Minimally invasive cardiac surgical techniques include the use of partial sternotomy for aortic valve and mitral valve replacement. Partial sternotomy is associated with less pain, better chest and upper-sternal stability, shorter hospital stays, and faster recoveries. However, aortic arch operations are still typically performed through median sternotomies. We describe the case of a 77-year-old woman who underwent elective hemiarch replacement because of an asymptomatic ascending aortic aneurysm. She requested a minimal incision. Our J-shaped partial lower sternotomy adequately exposed the proximal aorta and enabled all cannulations to be performed through the sternotomy. The patient had an uncomplicated postoperative course. We think that a partial sternotomy for ascending aortic and hemiarch replacement can be considered in selected patients for whom the procedure's benefits are important.

Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis

“…Well-established operations of the aortic root, such as the Bentall-De Bono [4] and valve-sparing root replacement (David) [5] procedures, can now be performed via much smaller incisions. Additionally, minimal access techniques have proven to be diverse approaches, allowing the surgeon to carry out isolated or concomitant procedures of the aortic arch [6,7]. Numerous case series assessing MIS have found it to be safe in selected patients [8][9][10].…”