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ABSTRACT 102
PORT-ACCESS AORTIC VALVE REPLACEMENT
Donald Glower
Duke Univ, Durham, NC
Purpose: To apply port-access techniques to aortic valve
operation (AVR} via right thoracotomy.
Methods: A 60yo lady presented with severe aortic stenosis
after pervious median sternotomy. 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 was cannulated through the incision. A percutaneous
25Fr venous catheter was passed from the femoral artery into the
right atrium. Once on pump, AVR was conducted in the standard
fashion using a flexible external aortic clamp. Laparoscopic instruments
can be used but are not necessary. 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, a small right thoracotomy with modified port-access techniques
is an excellent option. Advantages relative to other sternal
splitting incisions include avoidance of sternotomy, excellent
cosmesis, and few wound complications.
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