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J Thorac Cardiovasc Surg 1997;114:686
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Partial sternotomy: A mini approach for maxi exposure

Suite 322
580 Lincoln Park Blvd.
Kettering, OH 45429-3493

To the Editor:

In response to a letter to the Editor by Moreno-Cabral in the Journal (1997;113:810-1), I want to endorse his enthusiasm for the partial lower sternotomy. I, too, have been frustrated with the limitations of exposure of the heart via left and right anterolateral thoracotomy. In contrast, partial lower sternotomy up to the second intercostal space with bilateral transection of the sternum at the top of the incision allows adequate exposure for a wide variety of operations.

Over the past 3 months, I have performed 29 operations using partial lower sternotomy. All patients received from one to five coronary bypasses; in 26, the left internal thoracic artery was used and, in one, the right internal thoracic artery. In addition, two had resection of a left ventricular aneurysm, one replacement of both the aortic and mitral valves, and two replacement of the aortic valve. In one patient (coronary bypass plus double valve replacement), the sternal incision was extended to the first intercostal space and the sternum was transected at that level.

Postoperative pain was less than in patient with anterolateral thoracotomies. Blood loss was less than in patients with complete sternotomy. The skin incision was shorter than with complete sternotomy and only slightly longer than that need for the anterolateral thoracotomy approach.

Partial sternotomy is a worthwhile alternative to complete sternotomy and has many of the advantages of other minimally invasive techniques.

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