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Aortic valve replacement after substernal colon interposition.

A M Gillinov1, F P Casselman, D M Cosgrove

  • 1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.

The Annals of Thoracic Surgery
|April 24, 1999
PubMed
Summary
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A minimally invasive right parasternal incision enabled safe aortic valve replacement in a patient with prior esophageal surgery. This approach avoided complications associated with traditional median sternotomy in complex cases.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery

Background:

  • Aortic stenosis necessitates valve replacement, often via median sternotomy.
  • Substernal abnormalities, such as colon interposition after esophageal resection, can complicate traditional surgical approaches.

Observation:

  • A 60-year-old male patient with a history of esophageal resection and colon interposition presented with severe aortic stenosis.
  • Conventional median sternotomy was deemed high-risk due to the substernal colon graft.

Findings:

  • A modified 8-cm right parasternal incision was utilized for aortic valve access.
  • Cardiopulmonary bypass was established using femoral and right atrial cannulation.
  • The right parasternal approach provided adequate exposure of the aorta and left ventricular outflow tract, facilitating safe valve replacement.

Related Experiment Videos

Implications:

  • The right parasternal approach offers a viable alternative for aortic valve replacement in patients with complex substernal anatomy.
  • This technique may reduce the risks associated with median sternotomy in selected patient populations.
  • Minimally invasive cardiac surgery strategies can be adapted for challenging anatomical situations.