Miniesternotomia para a cirurgia da valva aórtica: experiência inicial

Abstract

É apresentada a experiência inicial com a cirurgia minimamente invasiva para o tratamento das afecções da valva aórtica, através da miniesternotomia em L invertido. No período de junho a novembro de 1997, 12 pacientes adultos foram submetidos a troca da valva aórtica. A técnica cirúrgica constitui-se na substituição da valva aórtica por prótese biológica, através de minitoracotomia, com esternotomia parcial do tipo L invertido, estendendo-se da fúrcula ao quarto espaço intercostal direito. O reduzido trauma cirúrgico proporcionou recuperação mais precoce. Em 1 (18,3%) caso, houve necessidade de conversão para esternotomia total por dificuldade de saída de CEC. A evolução tardia foi obtida em 11 (91,6%) casos, estando todos os pacientes assintomáticos.<br>We present our initial experience with minimally invasive surgery for the treatment of aortic valve diseases, through a minithoracotomy. From June to November of 1997, 12 patients underwent aortic valve replacement. The surgical technique utilized was ministernotomy from the notch to the fourth right intercostal space. There was no mortality, nor reoperation. There was necessity of complete sternotomy in one case because of difficult of leaving CPB. Late evolution was possible in 91.6% of the cases and they are all free of symptons

Mini-sternotomy for the treatment of aortic valve lesions

“…We do not consider it necessary to extend the incision as far as the 4 th intercostal space 5 , because the 3 rd intercostal space provides enough room for the creation of the pouch in the right atrial auricle, as well as for drainage of the left chambers through a catheter introduced into the superior pulmonary vein.…”

“…To avoid this problem, Steven Gundry, from Loma Linda, proposed access through mini-sternotomy, with an incision extending from the manubrium of the sternum to the 3 rd intercostal space, where the incision is deviated to the right, like an inverted L, preserving the right internal thoracic artery 4 . Dias et al 5 reported an initial experience with mini-sternotomy, extending the incision to the 4 th intercostal space. All these controversial approaches resulted in a panel discussion 6 in which Steven Gundry enthusiastically supported this access approach.…”

Acesso minimamente invasivo para troca da valva aórtica: resultados operatórios imediatos comparativos com a técnica tradicional

“…They considered this approach advantageous allowing utilization of the regular equipment used in traditional surgeries as it does not need cannulation of the femoral veins, as well as enabling the rapid conversion to total sternotomy. Since then, this access has been widely used in different institutions [3,[8][9][10].…”