Aortic And Mitral Valve Replacements Through J-type Partial Sternotomy Extending To The Third Right Intercostal Space.
Oleg Orlov, Cinthia Orlov, Marios Kyriakos, Matthew Thomas, Konstadinos Plestis.
Lankenau Medical Center, Philadelphia, PA, USA.
OBJECTIVE: Access to the mitral and aortic valves in patients undergoing combined mitral and aortic surgery is traditionally performed via a full sternotomy. We demonstrate the feasibility of performing concomitant aortic and mitral valve replacement via a partial upper sternotomy.
METHODS: An 86-year-old male with hypertension, CHF and without coronary artery disease presented with severe aortic and mitral valve regurgitation. A six centimeter skin incision and an upper partial sternotomy with extension to the third right intercostal space was performed. The right common femoral vein was exposed, heparin administered and the ascending aorta and femoral vein cannulated using Seldinger technique. A separate cannula was placed directly into the right atrium to assist with venous drainage, the aorta cross-clamped and the heart arrested with a single dose of antegrade HTK-Custodiol solution.
RESULTS: The aorta was transected 1 cm above the Sinotubular junction and additional cardioplegia was given directly into the coronary artery ostia. A pulmonary vent was inserted and the dome of the left atrium exposed and incised. The mitral valve was visualized and the anterior leaflet removed. A series of interrupted pledgeted sutures were placed into the annulus of the mitral valve, the prosthesis lowered into place, the sutures tied with the Cor-Knot device and the dome of the left atrium closed. Attention was then turned to the aortic valve. The aortic valve leaflets were resected and interrupted annular sutures placed. The annular sutures were brought through the valve sewing cuff, the valve lowered into place and the sutures tied using the Cor-knot device. The aortotomy was then closed in two layers and the chest closed in a standard fashion. The patient was weaned off cardiopulmonary bypass without any difficulties. The patient had an uneventful hospital course.
CONCLUSIONS: Concomitant aortic and mitral valve surgery can be safely performed via a mini-sternotomy. This surgical approach provides excellent exposure to both the aortic and mitral valves and has the added benefit of a minimally invasive approach with respect to patient recovery.
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