Sutureless Prosthesis Implantation and Ascending Aorta Replacement Through a Ministernotomy Approach

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A significant proportion of patients undergoing aortic valve replacement have a dilated ascending aorta; presence of an ascending aorta aneurysm is viewed as a contraindication for sutureless valve implantation for the potential risk of prosthesis dislodgment. We describe our technique of sutureless prosthesis implantation and concomitant ascending aorta replacement through an upper ministernotomy. Seven patients underwent aortic valve replacement with a sutureless prosthesis and concomitant ascending aorta replacement between November 2014 and October 2016. A J-shaped upper ministernotomy was performed in all patients. Diameter of vascular graft for the replacement of the dilated ascending aorta was chosen according to the size of the selected prosthesis, to recreate a ratio between diameters of the new sinotubular junction and the aortic annulus that should be less than 1.3. Postoperatively. no patient died in hospital. No paravalvular leakage or prosthesis dislodgment was reported. Mean ± SD cardiopulmonary bypass and cross-clamp times were 142 ± 52 minutes and 85 ± 18 minutes, respectively. In patients undergoing aortic valve replacement and ascending aorta replacement, sutureless valve implantation is a safe and reproducible procedure associated with good postoperative results.

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