Suraj Wasudeo Nagre
Department of CVTS, Grant Medical College, Mumbai, India
Received: 16 August, 2016; Accepted: 29 August, 2016; Published: 30 August, 2016
Dr Suraj Wasudeo Nagre, MBBS, MS, M.Ch, CVTS, DNB, CVTS, Associate Professor, Department of CVTS, Grant Medical College, 31, Trimurti Building, J J Hospital compound, Byculla, Mumbai, India, Mobile no -09967795303; E-mail:
Nagre SW (2016) Hurdles for Starting Ministernotomy Aortic Valve Replacement Program. J Cardiovasc Med Cardiol 3(1): 035-037. DOI: 10.17352/2455-2976.000029
© 2016 Nagre SW. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Aortic valve; Ministernotomy; CPB (cardiopulmonary bypass); VR (aortic valve replacement)
Research article regarding hurdles for starting ministernotomy Aortic valve replacement program in Grant Medical College, Mumbai and techniques to overcome them. Here we studied twenty patients of aortic valve replacement surgery out of which ten are operated by ministernotomy and ten by full sternotomy in our institution, from May 2013 to May 2016.Middle age patients are selected out of which seven had regurgitant and three had stenotic lesion of aortic valve. Our observations are sternotomy time was more in initial cases but it decreased with experience. We faced difficulties in deairing heart and giving shock with routine internal shock paddles. It required special sterile external shock paddles. We required conversion to full sternotomy in two patients because heart continued to fibrillate even giving shock with paediatric internal shock paddles. CPB time, cross clamp time, CCU stay was same as compared to full sternotomy AVR patients. Cosmetically incision was better. Even with early difficulties and hurdles we continued our efforts to improve and succeeded in it. Ministernotomy AVR will always maintain its place in between full sternotomy AVR and minithoracotomy AVR.
In this era of percutaneous interventions and minimal invasive surgery, ministernotomy aortic valve replacement is good option to start minimal invasive cardiac surgery in any institute. Aortic valve replacement seems more feasible through ministernotomy as aorta is anterior structure and cannulation required can be done through exposed aorta and right atrium . Most importantly it can be done with same intruments that are used in conventional full sternotomy aortic valve replacement. Patients with same criteria (Table 1), are selected and divided into two groups. In Group one 10 cases undergone ministernotomy AVR anvd in Group two 10 cases undergone conventional full sternotomy AVR .Observations in both groups are compared.
Patients and Methods
Twenty patients of aortic valve replacement surgery - ten by ministernotomy and ten by full sternotomy studied at our institution Grant Medical College, Mumbai from May 2013 to May 2016.
In both groups, techniques used for heparinisation, cannulation (Figure 1), going on bypass, aortic valve excision (Figure 2a,b), mechanical valve used ,suturing technique (pledgetted ethibond with pledget on left ventricle side), all are same. Intraopt and postopt observations in both groups are compared.