Aortic and Mitral Valve Replacements Through J-Type Partial Sternotomy

This video demonstrates a technique for performing aortic and mitral valve replacements simultaneously through a partial sternotomy with an excellent exposure of the corresponding anatomical structures. The patient was an 86-year-old male patient who presented with a case of severe aortic and mitral valve regurgitation, CHF, and hypertension. A minimally invasive approach was performed through a 6 cm skin incision and an upper partial sternotomy with extension to the third right intercostal space.

The Seldinger technique was utilized to cannulate the ascending aorta and the right femoral vein to establish cardiopulmonary bypass. The aorta was cross-clamped and the heart was arrested with a 2-liter single dose of HTK-Custodiol cardioplegia. The aorta was transected above the sinotubular junction and the remaining cardioplegia was given directly into the coronary artery ostia. A traction suture on the aorta was placed to aid the exposure of the left atrial dome. An incision was made in the dome of the left atrium to expose the mitral valve. The valve was exposed with an Estech retractor. The anterior leaflet of the mitral valve was removed. A series of interrupted 2-0 Ethibond pledgeted sutures were placed into the annulus of the mitral valve. The prosthesis was lowered into place and the sutures were tied with a Cor-Knot. The dome was closed with 4-0 Prolene sutures in a continuous fashion in two layers. Attention was then switched to the aortic valve.

The aortic valve leaflets were removed and a series of interrupted 2-0 Ethibond pledgeted sutures were placed into the annulus of the aortic valve. The sutures were passed through the sewing ring of bioprosthesis. The prosthesis was lowered into place and the sutures were tied with a Cor-Knot device. The aortotomy was closed in two layers with 5-0 Prolene sutures in a continuous fashion. The patient was closed in a standard fashion and had an uneventful hospital course.