Further Considerations
Step 1. Combination of Minimally Invasive Incisions
◆
An intrapericardial implantation of a left ventricular assist device in the
younger patient could be performed through a combination of an upper partial
sternotomy and a left anterolateral thoracotomy. This procedure possibly
reduces intrapericardial adhesion and facilitates the heart transplantation.
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Figure 1.7 By
the clamshell approach, the sternum is transversally divided at the level
between the 3rd and 5th intercostal space. The upper part of the thorax is
opened like a clamshell with retractors. Sternum wires and PDS pericostal
sutures are used to close and stabilize the thorax at the end of the procedure.
Step 2. Other Incisions
◆
Other incisions are used occasionally for extended exposure of the great
vessels. The clamshell approach (Fig. 1.7) enables access to the hilum of each
lung and is an option for bilateral lung transplantation or heart-lung
transplantation. This approach provides an excellent exposure of the heart and
descending aorta, and may be used for select cases that require extended aortic
surgery.
Keywords
: Cardiac
Surgical Techniques, Surgical Incisions, Basic Techniques, sternotomy,
partial sternotomy, lateral anterolateral thoracotomy, posterolateral
thoracotomy, Thoracotomy,
Approaches in Thoracotomy, Thoracotomy Closure, Further Considerations
