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Minimally Invasive David Procedure With Concomitant Mitral Valve Repair Through Mini-sternotomy
Eduard Charchyan, Denis Breshenkov, Yuriy Belov.
Petrovskiy Russian Research Center of Surgery, Moscow, Russian Federation.

BACKGROUND: Often, patients with aortic root aneurysm and aortic valve insufficiency have associated mitral valve insufficiency. In most cases, performing valve-sparing procedures in these cases requires a full sternotomy. However, it is possible to perform a minimally invasive procedure through the upper median ministernotomy (MS). There is no common algorithm, so we present our strategy of the mini-David procedure with concomitant mitral valve repair.METHODS: In this case, we present a step-by-step technique of mini-David procedure with mitral valve repair using the J-shaped MS via 3rd ICS. A 53-years-old male presented with an aortic root aneurysm and severe mitral insufficiency. This video showcases the tips and tricks of how to perform an approach to the mitral valve through the left atrium roof and the technique of minimally invasive David procedure.RESULTS: In an experienced surgical centre and with accurate patient selection, performing concomitant valve-sparing aortic root repair and mitral valve repair through the left atrium roof is a safe and effective procedure.CONCLUSIONS: Upper J-shaped mini-sternotomy is a safe, effective and reproducible procedure for valve-sparing aortic root repair with concomitant mitral valve repair. Some tips and tricks help with providing optimal exposure and technical difficulty that is no different than full sternotomy.

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