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J Thorac Cardiovasc Surg 1998;115:1390
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Minimal-access redo aortic valve replacement

Kiyofumi Morishita, MD, Kenji Kuwaki, MD, Hiroki Sato, MD, Tomio Abe, MD

Reply to the Editor:

In the October 1997 issue of the Journal, Tam, Garlick, and AlmeidaGo 1 described an elegant approach for redo aortic valve replacement (AVR). We also have used this upper hemisternotomy without horizontal transection of the sternum for redo AVR. Inasmuch as this approach does not require dissection of adhesions between the right ventricle and the lower sternum, it can minimize operative time. Moreover, the exposure of the ascending aorta is so excellent that the total pump time is not prolonged. We share their opinion that redo AVR can be performed safely via this approach.

We have two comments.

First, these authors remarked that this approach is also suitable for primary AVR. However, when the patient wears a V-necked sweater, the operative scar is apparent. With respect to cosmetic appearance, this upper hemisternotomy is less advantageous than other small incisions, such as the transverse incision, parasternal incision, or mini-T sternotomy.Go 2 For primary AVR, a parasternal incision or mini-T sternotomy seems to be desirable. Therefore we believe this approach should be limited to redo AVR.

Second, they stated that they could not cannulate the right atrial appendage because of scarring. On the basis of our experience, an upper part of the right atrium is exposed easily. Through this exposure, a cannulation can be performed without difficulty.

We wish to congratulate Tam, Garlick, and Almeida on their contribution to minimally invasive techniques for cardiac surgery, which are still evolving.

Department of Thoracic and Cardiovascular SurgerySapporo Medical University School of Medicine, Sapporo, Japan

References

  1. Tam RKW, Garlick RB, Almeida AA. Minimally invasive redo aortic valve replacement. J Thorac Cardiovasc Surg 1997;114:682-3.[Free Full Text]
  2. Moreno-Cabral RJ. Mini-T sternotomy for cardiac operations. J Thorac Cardiovasc Surg 1997;113:810-1.[Free Full Text]




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