Minimally invasive aortic valve replacement

Partial upper sternotomy results in excellent exposure and a safe conduct of a variety of operations on the aortic valve and ascending aorta. The sternotomy extends into the right fourth intercostal space and is performed through an 8-10 cm long skin incision. The pericardium is open in the midline and aorta and right atrium are cannulated directly. Aortic valve is exposed through the oblique aortotomy, after placement of retraction sutures to the commissures. The aortic valve is excised and annulus meticulously debrided. Aortic valve prosthesis is then inserted into the annulus using a pledgeted non-absorbable suture. The procedure is performed with the usual surgical instrumentation and can therefore be easily adopted. We discuss the indications, surgical technique and results of this technique.