A new approach to cardiac valve replacement through a small midline incision and inverted L shape partial sternotomy.

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Abstract
Objective: Minimally invasive cardiac surgery is becoming more popular as an alternative technique in some cardiac operations. We report our experience with an inverted 'L' ministernotomy in 25 patients and describe the technical details of this new approach. Methods: From June 1996 to February 1997 we performed 25 ministernotomy approaches for cardiac surgery, 17 aortic and 7 mitral valve replacements and 1 atrial septal defect closure. A comparison group included all patients (n=126) operated on for mitral or aortic valve replacement through a median sternotomy since June 1996. Results: Ventilatory support, Intensive Care Unit stay and hospital stay were 8.3 h (SD=4 h), 25 h (SD=8 h) and 5.5 days (SD=3 days) in the L ministernotomy group and 11.5 h (SD=5), 53 h (SD=11) and 9.1 days (SD=4 days) in the median sternotomy group (P≪0 05). Mortality and morbidity are similar to conventional sternotomy (hospital mortality 4% vs. 5.5%; P not significant). Conclusions: We conclude that inverted L ministernotomy for cardiac surgery is a safe approach and can offer some advantages over the conventional approach.

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