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Chiu. Mini-invasive Surg 2017;1:81-8 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.03
www.misjournal.net
Original Article Open Access

Modified parasternal approach is a good

alternative for aortic valve surgery

Kuan-Ming Chiu 1,2,3

1 Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City220, Taiwan.
2 Department of Nursing, Oriental Institute of Technology, New Taipei City220, Taiwan.
3 Department of Photonics Engineering, Yuan Ze University, New Taipei City 220, Taiwan.

Correspondence to: Dr. Kuan-Ming Chiu, Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, 13F, No. 21,
Sec. 2, Nan-Ya S. Rd., Banqiao District, New Taipei City 220, Taiwan. E-mail: kmchius@yahoo.com.tw
How to cite this article: Chiu KM. Modified parasternal approach is a good alternative for aortic valve surgery. Mini-invasive Surg 2017;1:81-8.

Prof. Kuan-Ming Chiu, Vice President in Far Eastern Memorial Hospital (FEMH) and Chief of Cardiovascular
Center, Taiwan. He is the Council member of the Thoracic and Cardiovascular Surgeons of Asia (ATCSA), and
also serves as the Board member of several societies in Taiwan. Dr. Chiu has performed more than 5,000 cardiac
operations, including over 3,000 CABG, more than 1,500 valve surgeries, and 54 heart transplants. The core
competencies of his team at FEMH are in off-pump coronary artery bypass (OPCAB) and minimally invasive
cardiac surgery (MICS). In August 2010, Dr. Chiu and his team initiated the Da Vinci cardiac surgery procedures
and performed 52 such operations in past years. FEMH is considered a leader in endoscopic vessel harvest (EVH)
procedures (more than 2,100 cases of EVH experience, including 130 endoscopic radial artery harvests) and is
also a premier training center in Asia. Several foreign cardiac surgeons have been to FEMH for EVH and MICS
training. More than 85% of the isolated CABG procedures he performed were OPCAB. More than 85% of valve
procedures at FEMH are performed via the sternum-sparing approach (MICS). Dr. Chiu has been invited for oral
presentations and live demonstrations of his OPCAB and sternum-sparing MICS techniques in Japan, China, Hong Kong, Macau, Vietnam,
Malaysia, Singapore, India, Philippines and Korea. His expertise includes endoscopic mitral valve surgery, parasternal aortic valve (multi-
valve) surgery, and sternum sparing coronary artery bypass.
ABSTRACT

Article history: Aim: Cardiac surgery, as with other surgical specialties, has moved toward minimally invasive
Received: 09-02-2017 procedures. Currently, since the cardiopulmonary bypass machine remains necessary for most
Accepted: 12-05-2017 cardiac surgery procedures, efforts have focused on decreasing surgical trauma by limiting
Published: 30-06-2017 vascular access sites and any unnecessary dissection. This study presents the authors’ approach
for less invasive valve surgery, which aimed to avoid a conventional midline sternotomy
Key words: and reducing the length of incision. Methods: For patients with aortic valve involvement,
Parasternal approach, parasternal approach was the primary choice. A longitudinal 5-6 cm incision was made one
aortic valve surgery, fingerbreadth lateral to the sternal border. The 3rd rib was cut at the chondrosternal junction
modified parasternal incision, and bent into the right pleural cavity. After either central aortic or peripheral cannulation,
sternum-sparing aortic valve surgery, all procedures were completed under surgeon’s direct vision and conventional instruments.
minimally invasive aortic valve The rib was reduced into position with a wire to offer stability and eliminate postoperative
surgery chest deformity. Results: The authors’ experience of more than 500 cases with the minimally
invasive approach showed that bypass time and ischemic time for parasternal valve surgery
were compatible with to a full-sternotomy approach. In this series, postoperative ventilation

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