Esternotomia parcial mediana em H. Um novo acesso para a cirurgia cardíaca

Abstract

Purpose - To present our results with the minimally invasive thoracotomy (MIT) in patients with valve disease and to describe a new type of thoracotomy. Methods - Twenty-five patients with valve disease as the major cardiac problem were operated during a five month period. Two types of incisions were used: one in an inverted-T fashion and another in a Hfashion. Fourteen patients were submitted to an inverted-T incision and eleven to a H incision. In 24% of the patients reoperation was being performed. Results - The incisions ranged from 7.5 to 11cm (mean 9.1cm), mean ICU stay was 31h and hospital stay 4.8 days. In all but one patient the operation could be adequately in performed through the MIT, in only one patient total sternotomy had to be performed. Conclusion - The MIT may have some advantages such as, better aesthetic results, less pain and more sternal stability. These factors may improve early extubation and decrease hospital stay. The H type incision allows an adequate exposition of the most central part of the chest and all heart valves with adequate exposure. This technique led to no complications during reoperations and we believe it to be as safe as the total sternotomy.