Minimally Invasive Bentall Procedure via Right Axillary Access: A Step-by-Step Technique

This video demonstrates the feasibility and step-by-step technique of performing a Bentall procedure through a right axillary minithoracotomy in an adult patient with aortic root aneurysm and aortic valve disease. Cardiopulmonary bypass was established via femoral cannulation, and a 5–6 cm right axillary incision was used to access the ascending aorta and root with soft-tissue retraction and limited rib spreading. The operative steps included aortic cross-clamping, aortotomy, resection of the diseased root, composite valved conduit implantation, and coronary button reimplantation, all performed using long-shafted instruments and endoscopic assistance to preserve a fully minimally invasive approach. This video highlights key technical nuances related to exposure, myocardial protection, hemostasis, and de-airing, as well as strategies to avoid conversion to sternotomy. The postoperative course was uneventful, with excellent hemodynamic results and rapid recovery, supporting this right axillary access as a safe and reproducible minimally invasive option for selected Bentall procedures.

This video submission is from the 2026 CTSNet Instructional Video Competition. Stay tuned to CTSNet.org and the CTSNet YouTube channel in the coming weeks to watch all entries from the competition, including the winning videos.  

References

1. Di Eusanio M, Cefarelli M, Zingaro C, Capestro F, Matteucci SML, D’alfonso A, Pierri MD, Aiello ML, Berretta P. Mini Bentall operation: technical considerations. Indian J Thorac Cardiovasc Surg. 2019 Jun;35(Suppl 2):87-91. doi: 10.1007/s12055-018-0669-4. Epub 2018 Apr 2. PMID: 33061071; PMCID: PMC7525429.
2. Ji Q, Wang Y, Liu F, Yang Y, Li J, Sun X, Yang Z, Pan S, Lai H, Wang C. Mini-Invasive Bentall Procedure Performed via a Right Anterior Thoracotomy Approach With a Costochondral Cartilage Sparing. Front Cardiovasc Med. 2022 Mar 2;9:841472. doi: 10.3389/fcvm.2022.841472. PMID: 35310990; PMCID: PMC8924284.

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