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Sutureless Aortic Valve Replacement Via Right Anterior Thoracotomy

Tuesday, December 12, 2017

Isbir S, Arsan S, Birkan Y, et al.. Sutureless Aortic Valve Replacement Via Right Anterior Thoracotomy. December 2017. doi:10.25373/ctsnet.5677513.

The authors present a sutureless aortic valve replacement via a right anterior thoracotomy, using minimal extracorporeal circulation (MECC) in an 84-year-old patient with severe aortic stenosis.

Preoperative tomographic angiography showed a right-sided aorta. A 4 cm transverse incision was made through the right second intercostal space. Rib resection was not used. Femoral arterial and venous cannulation was used. MECC is known to reduce the deleterious effects of cardiopulmonary bypass, and the main advantages of MECC are a reduced inflammatory response and less hemodilution. By using standard surgical instruments, a transverse aortotomy was made from the fat pad. Calcified leaflets were resected, and a small size Perceval sutureless valve was inserted. The aortotomy was then closed. Postoperative transesophageal echocardiogram showed no leak and excellent hemodynamics. The patient’s recovery was uneventful.

Sutureless aortic valve replacement with minicardiopulmonary bypass through the right anterior thoracotomy is a safe and feasible technique and provides an excellent result.


Thank you for your nice video. I think there is one small mistake when you call it right-sided aorta. Actually, right-sided aorta (it usually refers to the aortic arch) is always accompanied with descending aorta on the right, while in your case it is clearly seen on computed tomography that the descending aorta is to the left of vertebral column as usual. However, 'right-sided aorta' does not seem to be the point of sutureless technique as aortic valve is fairly well accessed via the right anterior minithoracotomy in left-sided aorta even when conventional technique is used [for example, see one of the previous CTSNet Video:].

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