Right thoracotomy approach for open heart surgery

Though most cardiac operations are performed through median sternotomy because of its versatility and familiarity to surgeons, the fact is sternotomy is not without complications, and the problems of post sternotomy pain, dehiscence, mediastinitis, osteomyelitis and unstable sternum increases morbidity and mortality in these patients. Median sternotomy may also leave a bad scar which patients don’t prefer. Alternative to median sternotomy are gaining popularity in cardiac surgery. As an alternative to median sternotomy, the heart may be approached by (i) right parasternal mini-incision, aortic and central venous cannulation, (ii) right submammary mini-incision, femoral arterial cannulation and central venous cannulation, (iii) right submammary mini-incision, femoral arterial cannulation, right atrial cannulation and percutaneous jugular vein cannulation, (iv) parasternal incisions, the (v) hemisternotomy, the (vi) minithoracotomy, (vii) upper half sternotomy and or (viii) lower half sternotomy, (ix) lower small midline skin incision with minimal sternotomy approach, (x) transxiphoid approach without sternotomy. At times horizontal submammary skin incisions are used to split sternum to get the best post-operative results. The concept of alternative approaches for cardiac surgery started only when safety of open heart surgery was ABSTRACT