Esternotomia parcial como uma alternativa na abordagem cirúrgica das valvas atrioventriculares e doenças do septo interatrial

Abstract

Since its conception, cardiovascular surgery has posed several technical challenges to the surgeon. Maintaining the characteristic of constant improvement, cardiovascular surgeons have sought to reduce surgical trauma by developing minimally invasive techniques. From this perspective, the present study sought to establish a new modality among partial sternotomies, preserving the manubrium and the xiphoid process. This is a prospective, single-center, interventional study carried out with patients who underwent heart surgery in atrioventricular valves and interatrial septal diseases, at the Cardiac Surgery Department of the Hospital Universitário Pedro Ernesto (Hupe/UERJ), from January 2021 to June 2022, with the objective of evaluating partial sternotomy as an alternative in the surgical approach to atrioventricular valves and septal defects. Twenty patients with the following cardiovascular diseases were evaluated: mitral regurgitation (n=8, 40%); mitral stenosis (n=5, 25%); ostium secundum atrial septal defect (n=3, 15%); sinus venous atrial septal defect – superior vena cava (n=2, 10%); and myxoma (n=2, 10%). Patients underwent one of the following surgeries: mitral valve replacement (n=13, 65%), atrial septal defect repair (n=5, 25%) or atrial myxoma resection (n=2, 10%). Regarding the outcomes, only 3 (15%) patients required conversion to complete median sternotomy; there were no cases of surgical wound infection; the use of vasoactive drugs occurred in only 4 (20%) patients; there were no cases of stroke; only 1 patient presented anoxic encephalopathy that evolved to brain death; no patient required a pacemaker; there were 2 (10%) deaths: one from brain death and another from cardiogenic shock in the immediate postoperative period. The mean length of stay was 5.4 days. The results found in this study show a technically feasible procedure, with no significant increase in surgical time, with excellent results regarding the absence of surgical site infection, sternal stability and aesthetic result. Most patients returned to usual activities within the expected time.