Right Anterior Minithoracotomy Approach for Aortic Valve Replacement

Figures

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  Fig. 1.. Preoperative CT scans showing anatomical features favorable for RAMT AVR. (a) Preoperative CT scan is essential for RAMT. The ascending aorta should not be displaced leftward. On axial imaging at the level of the pulmonary artery bifurcation, at least half of the aorta should be to the right of the ipsilateral sternal border. At the pulmonary artery bifurcation, the aorta should be <10 cm deep to the chest wall at the midclavicular line. (b) Cannulation is most commonly performed femorally via percutaneous puncture or a small cutdown; thus, CT images should confirm adequate size and absence of severe calcification of the femoral vessels. AVR, aortic valve replacement; CT, computed tomography; RAMT, right anterior minithoracotomy.

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  Fig. 2.. Suggested patient and anatomical factors for selecting patients for RAMT AVR. Lack of these criteria is not a contraindication to RAMT AVR but will make the approach more challenging, and familiarity with the procedure should be considered. AR, aortic regurgitation; AVR, aortic valve replacement; CABG, coronary artery bypass grafting; RAMT, right anterior minithoracotomy.

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  Fig. 3.. Instruments that can be used to perform a right anterior minithoracotomy aortic valve replacement.