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ABSTRACT 41
PORT-ACCESS AORTIC + MITRAL VALVE REPLACEMENT
Donald Glower, Alan Kypson
Duke Univ, Durham, NC
Purpose: To apply port-access techniques to simultaneous
aortic and mitral valve operation (AVR/MVR}.
Methods: A 46yo lady presented with severe mitral stenosis
and moderate aortic regurgitation. An 8 cm incision was made
in the right 3rd interspace. The right 3rd
and 4th costal cartilages were detached from the sternum.
A standard pursestring was placed in the ascending aorta, and
the aortic cannula was passed through the chest wall and into
the aorta over a knife-tipped introducer. A percutaneous 25Fr
venous catheter was passed from the femoral artery into the right
atrium. Once on pump, AVR/MVR was conducted in the standard fashion
(transeptal approach to the mitral). Laparoscopic instruments
were used for the mitral but not the aortic valve. The groin stab
was repaired with 2 absorbable subcutaneous sutures. The rib
cartilages were reattached to the sternum using two #4 figure-of-eight
sternal wires.
Results: The postoperative course was unremarkable and
the patient was discharged on the 5th postoperative day.
Conclusions: In patients desiring minimally invasive
AVR/MVR, port-access techniques are excellent options with advantages
of avoiding sternotomy, excellent cosmesis, and few wound complications,
at the expense of longer procedure times.
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