Journal of Clinical and Experimental Cardiology
Open Access
ISSN: 2155-9880
ISSN: 2155-9880
Short Communication - (2026)Volume 17, Issue 7
Based on the intercostal spaces corresponding to the level of the left coronary artery ostium and the position of the the ascending aorta relative to the right border of the sternum on the axial CT view，it can effectively guide the use of lower median sternotomy in minimally invasive aortic valve replacement. Lower median sternotomy can offer distinct clinical and patient-centred advantages in terms of cosmetic outcomes, surgical ease, and procedural safety.
Aortic valve replacement; Minimally invasive surgery; Lower median sternotomy
Reccenlty, we have compared perioperative outcomes between minimally invasive lower median sternotomy and conventional full median sternotomy in patients undergoing isolated Aortic Valve Replacement (AVR) [1]. Lower median sternotomy represented a safe and feasible minimally invasive alternative to conventional approach, with equivalent intraoperative efficiency and early postoperative safety profiles, and offers superior cosmetic outcomes [1].
Rather than addressing the long-standing question of whether minimally invasive AVR yields outcomes as safe and effective as those with conventional approach, what is actually more important is that this clinical study has confirmed the effectiveness of our own developed method for guiding incision selection in minimally invasive AVR.
We use the intercostal space corresponding to the level of the left coronary artery ostium on preoperative CT to assess whether the planned incision allowed adequate exposure of the aorta and aortic root for AVR. We have found that patients who exhibit the following two characteristics in the axial CT view can be suitable for using a minimally invasive lower median sternotomy.
During the entire study period, all patients who met the CT anatomical criteria successfully completed the arterial perfusion, venous drainage cannulation, and valve replacement through a single incision in the lower part of the sternum. No additional peripheral vascular access was required.
It is not necessary to completely transect the sternum as in Fenton's method [2], but only need to make a 'J'-shaped incision on the sternum towards the second intercostal space on the left side. The skin incision with 8 cm-10 cm in length is vertically placed in the midline over the sternum and extended inferiorly starting from the third intercostal space.
Moreover, this incision selection method based on CT anatomical features can be universally applied in the preoperative planning of minimally invasive AVR.
The lower sternotomy incision avoids the visible upper chest area, allowing patients to wear V-neck clothing or jewelry without noticeable scarring, significantly improving health-related quality of life. Moreover, in procedures such as temporary pacemaker implantation and drainage tube placement, this incision is clearly safer and more convenient than the upper sternotomy. We once had a case where the upper sternotomy had to be converted to full sternotomy just due to the difficulty in stopping bleeding from the temporary pacing lead. However, this situation would never occur in the lower sternotomy incision.
Among patients undergoing minimally invasive AVR, there has always been a controversial issue as to which is better, right anterior thoracic incision or mini sternotomy [4]. The experience of Murzi’s team in AVR through the right anterior thoracotomy was associated with a low risk of cumulative failures from the outset, and no learning curve effect was observed. They believed that the patients undergoing this technique were not exposed to an increased operative risk also during the surgeon's initial experience [5]. Conversely, a review of 842 patients undergoing minimal access mitral valve repair identified that patients were significantly more likely to suffer complications at the beginning of the experience [6]. Another study of 3,895 patients undergoing minimally invasive mitral surgery demonstrated that surgeons needed to undertake between 75 and 125 operations to overcome the initial learning curve associated with the procedure [7]. Taking all of this into account, more surgeons still consider that AVR surgery performed through the right anterior chest incision is more technically challenging and associated with a steeper learning curve.
However, in AVR through minimally invasive lower median sternotomy, no new or unusual instruments are required and a familiar view to the surgeon can be exposed. Surgeons are easy to learn and adapt the approach, with a gentle learning curve. This can significantly enhance surgical flexibility and benefit patients.
The decision-making process of selecting the incision for minimally invasive AVR based on the anatomical features obtained from preoperative CT scans can bring convenience to the surgery. In patients with suitable anatomical conditions, performing the operation through lower median sternotomy will enhance the safety and convenience of minimally invasive AVR.
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Citation: Luo X (2026). An Effective Determination Method for Aortic Valve Replacement through Minimally Invasive Lower Median Sternotomy. J Clin Exp Cardiolog. 17:1020.
Received: 10-Jul-2026, Manuscript No. JCEC-26-43408; Editor assigned: 13-Jul-2026, Pre QC No. JCEC-26-43408 (PQ); Reviewed: 21-Jul-2026, QC No. JCEC-26-43408; Revised: 28-Jul-2026, Manuscript No. JCEC-26-43408 (R); Published: 04-Aug-2026 , DOI: 10.35248/2155-9880.26.17.1020
Copyright: © 2026 Luo X. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.