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Repair of Bicuspid Aortic Valve and Ascending Aortic Aneurysm Through Ministernotomy Approach

Monday, August 4, 2014

Bicuspid aortic valve affects about one percent of the population. It is a frequent cause of aortic insufficiency, and is also associated with aortic root or ascending aortic aneurysms. Techniques for aortic repair in patients with aortic insufficiency have been standardized and can be performed with satisfactory long term results. Minimally invasive aortic valve surgery has expanded in recent years, offering patients benefits in terms of improved postoperative recovery and cosmetic results. The authors present a case of minimally invasive repair of a bicuspid aortic valve and ascending aortic aneurysm through the upper ministernotomy approach.

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It is a bicuspid valve with associated ascending aneurysm. A hemiarch replacement in moderate DHCA with total resection of the aorta (no aortic tissue closure over the prosthesis) + David reconstruction of the root should have been performed to really treat the presented disease. Would the authors perform such a procedure also through a ministernotomy?
The root was not dilated and the sinotubular junction was preserved, so we did not consider a David reconstruction for this case. We do have a low threshold to perform hemiarch repair with DHCA, which can certainly be performed through a hemisternotomy approach by cannulating the aneurysm, and recanulating the aortic graft, although it was not considered for this case presenting a well delineated neck with good quality tissue. Finally, covering the aortic graft with native aortic tissue facilitates hemostasis, and provides additional protection in the event a young patient like this would require any additional cardiac surgery in the future.

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