[Concomitant Arrhythmic Surgery during Minimally Invasive Aortic Valve Replacement]

Here we demonstrate concomitant arrhythmic surgery during minimally invasive aortic valve replacement via a right mini-thoracotomy. This procedure is performed through the transverse sinus;therefore, skin incision should be laterally shifted. After cardiac arrest, pulling up the ascending aorta offers fine exposure of the transverse sinus. The left atrial appendage is resected by a surgical stapling device. Then the ligament of Marshall is divided and the pericardial reflection at the left upper pulmonary vein is bluntly dissected. The articulating radiofrequency clamp is introduced into the oblique sinus under the aorta and the left pulmonary veins are electrically isolated. Finally, aortic valve replacement is performed in a standard manner.