Partial Median “I” Sternotomy: Minimally Invasive Alternate Approach for Aortic Valve Replacement Johannes Boehm, MD, Paul Libera, MD, Albrecht Will,

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Partial Median “I” Sternotomy: Minimally Invasive Alternate Approach for Aortic Valve Replacement Johannes Boehm, MD, Paul Libera, MD, Albrecht Will, MD, Stefan Martinoff, MD, Stephen M. Wildhirt, MD, PhD The Annals of Thoracic Surgery Volume 84, Issue 3, Pages 1053-1055 (September 2007) DOI: 10.1016/j.athoracsur.2006.12.042 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The skin incision is about 7 to 8 cm, beginning 3 cm below the jugulum. (A) The underlying sternotomy is approximately 10 cm. (B) Intraoperative view of the sternum after the retractor has been placed. (C) Excellent access of the heart and aorta enables canulation and aortic valve exposure similar to what is obtained during aortic valve surgery with conventional sternotomy. The Annals of Thoracic Surgery 2007 84, 1053-1055DOI: (10.1016/j.athoracsur.2006.12.042) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Computed tomography scan of the chest was performed in a 63-year-old man 3 months after surgery. A reconstructive view showed the sternum from the (A) anterior, (B) lateral, and (C) posterior views. The sternal imaging was achieved by Siemens 64 multidetector row (Siemens Medical Solutions USA, Malvern, PA) computed tomography in a native scan. Axial slices with a thickness of 0.75 mm formed the raw data for three-dimensional reconstruction in a volume-rendering technique. Specially adapted window presets allow an anatomic view of the sternal region. The Annals of Thoracic Surgery 2007 84, 1053-1055DOI: (10.1016/j.athoracsur.2006.12.042) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions