Since the emergence of small skin incision aortic valve surgery in the late 1990s, minimally invasive aortic valve replacement has now become a viable alternative to standard full sternotomy. The spectrum includes (a) upper hemi sternotomy (T or J shaped), (b) lower partial sternotomy, and (c) right anterior mini-thoracotomy. Potential advantages include a cosmetically appealing scar, decreased post-operative pain and bleeding, shorter ventilation time and hospital stay, and early return to active life. The operative challenges include restricted view and access to the operative field, longer aortic cross-clamp time, and cardiopulmonary bypass time. This necessitates detailed pre-operative imaging, correct selection and assessment of patients, and good communication with perfusionists and anesthetists regarding the plan of each surgery, with a solid back-up plan in case conversion to full sternotomy is required intra-operatively. In recent times, the use of suture less valves and rapid deployment bio prosthesis has dramatically reduced operative time. Here, we describe the work-up, selection criteria, key steps, and potential pitfalls of the right anterior mini-thoracotomy approach for aortic valve replacement.
Part of the book: Cardiac Surgery Procedures
Type A Aortic dissection is a life-threatening emergency. It has varied clinical presentation from acute severe chest pain radiating to the back, collapse due to aortic rupture or pericardial tamponade or features of myocardial infarction, end organ or limb ischemia. The outcome is determined by the extent of the dissection, timing of presentation, comorbid factors, prompt diagnosis, adequate cerebral protection strategies, and skilled post-operative intensive care. Good immediate and mid-term results have been obtained with standard surgical techniques of aortic root, ascending aorta +/− hemi arch replacement. Endovascular techniques can be used as a hybrid procedure to provide more durable long term results.
Part of the book: Advances in Complex Valvular Disease