Direct Cannulation Through Right Anterior Mini Thoracotomy for Aortic Valve Replacement

To begin, a 5-6 cm incision was made in the right 3rd intercostal space, with the fourth rib sheared at the costochondral junction. The specific intercostal space used can be tailored to the patient. The authors prefer using the standard, centrally placed ascending aortic cannula with angled high superior vena cava (SVC) cannulation and a straight inferior vena cava cannula, which is passed through a separate SVC incision. If accessible, standard bicaval cannulation can be performed.  

Additionally, the surgeons used a right superior pulmonary vein vent. All patients received a standard aortic cross clamp and del Nido cardioplegia. Since this strategy is similar to the strategy used in a full sternotomy operation, it minimizes the new techniques that need to be learned to successfully perform the procedure. 

This method can be applied to both adult and pediatric patient populations with good results. This technique is an asset as it significantly reduces the cost of surgery. 

References

1. Kandakure PR, Batra M, Garre S, Banovath SN, Shaikh F, Pani K. Direct Cannulation in Minimally Invasive Cardiac Surgery With Limited Resources. Ann Thorac Surg. 2020 Feb;109(2):512-516.

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