Applied anatomical study on parasternal door approach

Objective To study the feasibility of parasternal door approach with an applied anatomical researching method. Methods The studies were carried out on ten cadavers. The blood supplying characteristics of the structures on deeper layers of the anterior thoracic wall were studied. The distributing regularity of internal thoracic artery was observed. The distance between internal thoracic artery and the lateral edge of sternum was measured in every intercostal space. Based on these anatomical characteristics, the novel approaches, parasternal door approach containing complicated tissue flap for cardiac operations was designed. Results The internal thoracic artery and its branches were the main nutrient artery for the structures of the deeper layers of anterior thoracic wall. The distance between the sternum and the internal thoracic artery was about 1 cm, which was wide enough for incising these two structures without injuring the internal thoracic artery. According to these characteristics, several parasternal door approaches could be designed. Right parasteral door approach could expose the structures on the right part of heart and ascending aorta satisfactorily, therefore several cardiac operations could be accomplished. Conclusion Parasternal door approach is a useful approach for cardiac operation, which has the advantages of invisible skin incision, short scar and less retraction. So it is a feasible minimally invasive approach for cardiac operations.