Easy Placement of Annular Sutures During Minimally Invasive Aortic Valve Replacement

Placing annular sutures at the right coronary cusp is difficult during minimally invasive aortic valve replacement. We propose the partial everting mattress method, whereby a prosthetic valve is implanted in a supra-annular position at the left coronary and noncoronary cusps, with pledgets on the left ventricular side, but in an intra-annular position at the right coronary cusp, with pledgets on the aortic side. Needles can be grasped in forehand pass at all three coronary cusps. Our method enables easy placement of annular stitches even in the small surgical field, without adversely influencing the hemodynamic performance of the prosthesis.