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Evaluation of Aortic Valve Replacement via the Right Parasternal Approach without Rib Removal
- Source :
- Annals of Thoracic and Cardiovascular Surgery. 21:139-145
- Publication Year :
- 2015
- Publisher :
- Editorial Committee of Annals of Thoracic and Cardiovascular Surgery, 2015.
-
Abstract
- 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.
- Subjects :
- musculoskeletal diseases
Adult
Male
Pulmonary and Respiratory Medicine
Aortic valve
Flail chest
medicine.medical_specialty
Time Factors
Lung hernia
medicine.medical_treatment
Operative Time
Ribs
complex mixtures
Postoperative Complications
Aortic valve replacement
Predictive Value of Tests
Risk Factors
medicine.artery
Multidetector Computed Tomography
Minimally invasive cardiac surgery
medicine
Humans
Aged
Retrospective Studies
Heart Valve Prosthesis Implantation
business.industry
Patient Selection
Gastroenterology
General Medicine
Middle Aged
medicine.disease
Sternotomy
Osteotomy
Surgery
enzymes and coenzymes (carbohydrates)
Treatment Outcome
medicine.anatomical_structure
Median sternotomy
Parasternal line
Aortic Valve
Right coronary artery
Original Article
Female
Radiology
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 21861005 and 13411098
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Annals of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....a3e201e79c7a16e18db1641970bed8b7