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OBJECTIVE: To demonstrate the feasibility of performing aortic valve repair and ascending aortic replacement via a mini upper sternotomy in a patient with an ascending aortic aneurysm, bicuspid aortic valve and severe aortic regurgitation.
METHODS: A 54 year old female presented with a bicuspid aortic valve (right and non-coronary cusps fusion), severe regurgitation and a 5 cm ascending aortic aneurysm. An inverse 5cm J-type mini sternotomy was done, extending to the right third intercostal space. The aortic arch was cannulated directly with the Seldinger technique. An endopulmonary vent was used. The right atrium was cannulated via the right common femoral vein, under TEE guidance, using the Seldinger technique. Two liters of HTK Custodiol cardioplegia were administered in an antegrade fashion to arrest the heart. The aorta was excised 1cm above the sinotubular junction and the aortic root was mobilized. The conjoined cusp of the bicuspid aortic valve was prolapsing. Free edge plication was used to repair the cusp. The Schaffers caliber was used to assess residual prolapse of the leaflets after the repair. Subcommissural annuloplasty was performed to reduce the annulus to 23mm in diameter.
A 24mm graft was anastomosed to the sinotubular junction and the distal anastomosis between the graft and aorta was performed 1 cm proximal to the aortic clamp. The distal aorta was wrapped with the residual graft and the patient was separated from cardiopulmonary bypass without difficulty.
RESULTS: The patient had an uneventful hospital course and was discharged to home on the 6th postoperative day. Transthoracic echocardiography revealed no aortic insufficiency.
CONCLUSIONS: This video demonstrates that aortic valve repair and concommitant ascending aortic replacement can be safely performed using a minimally invasive approach.