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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Reverse U aortotomy (Kırali incision) for aortic valve replacement.
1Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey imkbkirali@yahoo.com.
Asian Cardiovascular & Thoracic Annals
|March 12, 2015
Summary
Reoperative aortic valve replacement can be challenging due to prior coronary artery bypass grafts. A reverse U aortotomy technique offers a safer approach, improving exposure and minimizing risks during complex cardiac surgeries.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Reoperations for aortic valve replacement (AVR) after coronary artery bypass grafting (CABG) present unique surgical challenges.
- Patent saphenous vein grafts (SVGs) to the proximal aorta can impede access and increase risks during reoperative AVR.
Observation:
- A 65-year-old male patient required reoperative AVR two years post-valve-sparing aortic root replacement and CABG with an aorta-right coronary artery SVG.
- The surgical team employed a modified aortotomy technique to navigate the presence of the proximal aortic anastomosis and SVG.
Findings:
- A reverse U aortotomy, initiated 2 cm above the proximal anastomosis and extended to the prosthetic graft, was successfully utilized.
- This specific aortotomy approach facilitated excellent surgical exposure.
- The technique avoided potentially hazardous manipulation of the proximal anastomoses and the SVG.
Implications:
- The reverse U aortotomy is a secure and effective method for reoperative AVR in patients with prior CABG.
- This technique can mitigate complications associated with accessing the aorta in the presence of proximal vein grafts.
- Adoption of this approach may improve outcomes in complex cardiac reoperations.
