Mitral Valve Approaching through Median Sternotomy

Abstract

Median sternotomy remains the gold standard approach for mitral valve surgery, providing excellent exposure and facilitating complex repairs and replacements. This approach involves a longitudinal incision through the sternum, providing direct access to the heart and allowing for thorough visualization and manipulation of the mitral valve apparatus. The advantages of median sternotomy include superior exposure allowing for a comprehensive assessment of the mitral valve, surrounding structures, and associated pathologies. This facilitates complex repairs such as annuloplasty, leaflet repair, and chordal reconstruction, which may be challenging or impossible through minimally invasive approaches. The wide surgical field enables the surgeon to address concomitant cardiac issues, such as coronary artery disease or other valvular pathologies. The technique involves precise sternal division, cardiopulmonary bypass establishment, and cardiac arrest. The mitral valve is then exposed via direct visualization and manipulation. Following the completion of the valve procedure, the sternum is meticulously reconstructed using sternal wires or plates. While median sternotomy offers unmatched access, it is associated with significant postoperative morbidity, including prolonged hospital stays, increased pain, higher risk of infection, and a less aesthetically pleasing scar. Despite the development of minimally invasive techniques, median sternotomy remains the preferred approach for complex mitral valve pathologies requiring extensive surgical manipulation or in patients with significant comorbidities requiring a more robust and comprehensive surgical approach. The decision to utilize a median sternotomy approach is based on careful patient selection and consideration of the complexity of the mitral valve pathology. Despite its invasive nature, median sternotomy provides the surgeon with the tools and exposure necessary to address a broad range of mitral valve pathologies effectively and safely.