(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.