"Band aid" surgery: upper sternal split incision for valve surgery in adults. A modified technique.

ABSTRACT

A limited 10 cm upper sternotomy to the level of the third right intercostal space with preservation of the entire length of the left half of the sternum (quarter sternotomy) allows 1) exposure for aortic valve surgery; 2) utilization of standard equipment and cannulation techniques; 3) preservation of both internal thoracic arteries and 4) early discharge from the hospital. Three patients, all female, aged 45, 62 and 67, two with severe aortic insufficiency and one with severe aortic stenosis, underwent replacement. In two, a St. Jude's valve and in one, a Baxter pericardial valve were used. In addition, aortic decalcification-endarterectomy was carried out in one and re-exploration in another. All patients were discharged at 4 days, impressed by their "Band-Aid Surgery". Improved patient mobility and earlier recovery of ventilatory function are possibly related to this more stable form of limited sternotomy.