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Minimally Invasive Surgery
Volume 2014, Article ID 681371, 3 pages
Clinical Study

The Arrowhead Ministernotomy with Rigid Sternal Plate Fixation: A Minimally Invasive Approach for Surgery of the Ascending Aorta and Aortic Root

1Barnabas Heart Hospitals, Newark Beth Israel Medical Center, 201 Lyons Avenue, Suite G5, Newark, NJ 07112, USA
2Cardiovascular Clinical Research Unit, Barnabas Heart Hospitals, Newark, NJ 07112, USA
3Section of Cardiac and Thoracic Surgery, University of Chicago, Chicago, IL 60637, USA
4Division of Cardiac Surgery, Rush University, Chicago, IL 60612, USA

Received 27 June 2014; Accepted 5 November 2014; Published 18 November 2014

Academic Editor: Stephen Kavic

Copyright © 2014 Mark J. Russo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Ministernotomy incisions have been increasingly used in a variety of settings. We describe a novel approach to ministernotomy using arrowhead incision and rigid sternal fixation with a standard sternal plating system. Methods. A small, midline, vertical incision is made from the midportion of the manubrium to a point just above the 4th intercostal mark. The sternum is opened in the shape of an inverted T using two oblique horizontal incisions from the midline to the sternal edges. At the time of chest closure, the three bony segments are aligned and approximated, and titanium plates (Sternalock, Jacksonville, Florida) are used to fix the body of the sternum back together. Results. This case series includes 11 patients who underwent arrowhead ministernotomy with rigid sternal plate fixation for aortic surgery. The procedures performed were axillary cannulation (), aortic root replacement (), valve sparing root replacement (), and replacement of the ascending aorta () and/or hemiarch (). Thirty-day mortality was 0%; there were no conversions, strokes, or sternal wound infections. Conclusions. Arrowhead ministernotomy with rigid sternal plate fixation is an adequate minimally invasive approach for surgery of the ascending aorta and aortic root.