Right mini-thoracotomy Bentall with traditional and automated suturing devices

Bentall procedures are traditionally performed through a median sternotomy. However, minimally invasive approaches are increasingly being utilized. A right mini-thoracotomy approach may improve postoperative recovery.  A 5-cm mini-thoracotomy is performed in the right 2nd intercostal space. A camera port is placed lateral to this incision. Peripheral cannulation is performed. The ascending aorta is cross-clamped. Cardioplegia is administered and the patient is placed in deep hypothermic circulatory arrest to construct the distal aortic anastomosis. Aortic leaflets are excised and the annulus is sized. Annular and prosthetic sutures are placed using shafted instruments or automated suturing devices. The coronary buttons are reimplanted and a graft-to-graft anastomosis is constructed.  The Bentall procedure can be done safely through a right mini-thoracotomy in select patients and we demonstrate our technique in this video tutorial. Automated suturing devices and video guidance may facilitate this procedure.