(b) Surgical technique
Majority of isolated aortic valve replacements (12 of 19) were done by
MI approach either right anterior thoracotomy or upper partial
sternotomy.
Right anterior thoracotomy was used for right-ward aorta and α angle
≥45, whereas upper partial sternotomy was used for centric aorta. In
both of these approaches, peripheral cannulation was done to establish
CPB.
In combined operations like AVR+CABG, full median sternotomy was done
and CPB was established by aortic and right atrial cannulation.
Aortic valve was approached through transverse aortotomy about 2cm above
the conventional incision near the fat pad on ascending aorta. Diseased
aortic valve was excised in toto and all calcium was removed. In all
patients myocardial protection was achieved by Del Nido Cardiopegia.