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Novel Application of an Upper Hemi-Sternotomy to AAOCA

Monday, March 17, 2014

Operative repair for anomalous aortic origin of a coronary artery (AAOCA) has been described using various innovative techniques. Common to each report is the use of a full sternotomy. As demand for minimally invasive approaches to adult cardiac surgery has increased, the upper hemi-sternotomy has emerged as a safe and effective technique for aortic valve and root replacement. Most described techniques for operative repair of AAOCA require similar exposure to that of aortic valve and root replacement, and thus represent logical, yet not previously demonstrated, applications of an upper hemi-sternotomy. This video demonstrates the use of the upper hemi-sternotomy to perform a coronary unroofing procedure. The exposure is quite satisfactory and appears applicable to all described forms for AAOCA repair, with the exception of coronary artery bypass grafting.


Congratulations on the excellent outcome for correction of anomalous aortic origin of coronary arteries through a minimally invasive approach. Although the others state this hasn't been reported previously, the groupe from Brigham & Women's Hospital previously described using a minimally invasive approach through an upper hemi-sternotomy in 2006 (see Brinkman T et al. J Card Surg 2006;21(6):503-4, with similar excellent clinical and esthetic results.

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