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Related Experiment Video

Updated: Apr 16, 2026

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
08:50

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Reverse U aortotomy (Kırali incision) for aortic valve replacement.

Kaan Kırali1

  • 1Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey imkbkirali@yahoo.com.

Asian Cardiovascular & Thoracic Annals
|March 12, 2015
PubMed
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.

Keywords:
Aortic valve insufficiencycardiovascular surgical procedurescoronary artery bypassheart valve prosthesis implantation

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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.