Redo Aortic Valve Replacement Via Partial Upper Resternotomy

In this video, the authors present a case of 72-year-old male patient undergoing a redo aortic valve replacement via partial upper resternotomy. The patient had a history of a bioprosthetic aortic valve replacement via partial upper sternotomy in 2012, with a 25 mm valve. 

Preoperative transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) showed a severely degenerated bioprosthesis with severe regurgitation. Preoperative angiography excluded relevant coronary artery stenosis. Cardiovascular risk factors included hypertension and hyperlipoproteinemia. The patient suffered from shortness of breath and chest pressure while hiking. He was considered a good candidate for a redo aortic valve replacement via upper partial resternotomy. 

The old scar was excised, and the underlying subcutaneous tissue was dissected. The old threads were removed, and a T-form partial upper resternotomy was performed. Severe pericardial adhesions were dissected. 

A standard canulation of the ascending aorta and right atrium was performed. In patients with more severe pericardial adhesions, femoral cannulation could be useful. The aorta was cross-clamped, and the heart was arrested using cold Bretschneider cardioplegia delivered directly into the coronary ostia. 

The explanted bioprosthesis showed severe calcifications and a torn cusp. A standard implantation of a 25 mm bioprosthesis was performed using 2-0 Ethibond sutures. 

The aorta was closed, the heart was deaired, and the cross-clamp was removed. The patient was successfully weaned from cardiopulmonary bypass. A singe substernal drainage tube was inserted, and the chest was closed in a standard fashion. Intraoperative TEE as well as postoperative TTE confirmed good prosthesis function without signs of paravalvular leakage. 

The patient was transferred to the ICU without catecholamines and was extubated four hours after surgery. 

After an uneventful hospital stay, the patient was discharged on the seventh postoperative day. 

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