Deep Dive Into Aortic Surgery: 5 cm Access Aortic Surgery and Myocardial Protection

This video demonstrates one way to arrest the heart in a mini-access aortic root replacement procedure. The method described is suitable for patients with aortic regurgitation. The 5 cm incision provides adequate access for distal ascending aortic cannulation, aortic cross-clamping, and antegrade cardioplegia delivery via an aortic root needle. The venous drainage is achieved via the right femoral vein using a multiperforated venous cannula. Retrograde cardioplegia is not required and left ventricular venting is achieved via a direct transaortic approach using a small pediatric drop-vent once the aorta is opened. 

The key steps in this approach include: 

1.    Applying aortic cross clamp under a low flow condition using a double-clamp technique 
2.    Venting aortic root and left ventricle completely via the aortic root needle 
3.    Infusing antegrade cardioplegic solution slowly to allow the cardioplegia to be ejected with each heartbeat into the coronary circulation in a pressure-controlled fashion 
4.    Monitoring left ventricular distension and pulmonary pressure elevation once the heart fibrillates or arrests
5.    Providing adequate ostial cardioplegia to achieve complete diastolic arrest once the aorta is opened

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