The aortic valve is usually under or immediately behind the top half of the sternum. To access the aortic valve, a minimally invasive approach can be used. Depending on the size and tortuosity of the aorta, this valve could be on the left or right of the midline.
The approach to the aortic valve can be either through a right mini-thoracotomy through the 3rd intercostal space or through an upper mini-sternotomy. The choice of the approach depends on the experience of the surgeon and the team performing the procedure
Minithoracotomy -Works best if there is a rightward curve to the aorta and the aortic valve is slightly to the right of the midline.
Typically, this is an incision that extends from the midline to the right side for about 8 to 10 cm in the right upper chest.
The limitations of the mini-thoracotomy
- Not very effective if the ascending aorta needs to be repaired or replaced
- Limited approach to the aortic valve
- Limited approach to the mitral, tricuspid valves
The limitations of the mini-sternotomy
- If the aortic valve is below the level of the 3rd intercostal space, this makes the approach almost unusable
- Access to the right atrium may be limited – especially for cannulation and insertion of retrograde cardiolplegia
- Therefore, it may be a limiting incision if tricupid valve intervetion is recovered
- If coronary artery bypass graft surgery is required to the left anterior descending artery or the circumflex coronary artery, this approach is not suitable