A New Path: Right Vertical Infra-Axillary Mini-Thoracotomy For Bentall Procedure.

OBJECTIVE: Minimally invasive surgery of the ascending aorta has been becoming increasingly popular. For this purpose, the most frequently used incisions are mini-sternotomy and right anterior mini-thoracotomy. We report a new approach that can be safely performed in ascending aorta and/or aortic root pathologies through right infra-axillary vertical mini-thoracotomy. Methods: While implementing this approach, it was taken into account that our first patient did not have active endocarditis and had not undergone cardiac surgery before. He had dialysis dependent chronic kidney disease and his predicted mortality rate by EuroSCORE II was 5.27 %. The infra-axillary mini-thoracotomy was performed through a 8-cm vertical skin incision centering the right fourth intercostal space on the anterior axillary line. Results: The patient was 63 years old. He was undergone the Bentall procedure using an aortic valve bioprosthesis implanted in 30 mm - Dacron tube graft. Cardiopulmonary bypass time and median cross-clamp time were 106 minutes and 169 minutes, respectively. No morbidity or complication was observed. Conclusions: The Bentall procedure with a minimally invasive approach using a right vertical infraaxillary mini-thoracotomy can be a safe alternative to the standard in selected patients presenting with ascending aortic and/or complex aortic root pathologies. [ABSTRACT FROM AUTHOR]