Technical points for aortic valve replacement through right anterior minithoracotomy

After 8 years of practice and over 400 operated patients, we present a technique of minimally invasive aortic valve replacement that can be used by all surgeons on many patients. The access to the aorta is via the 2nd or 3rd right anterior intercostal space. Cardiopulmonary bypass is provided using the femoral artery and vein. The aorta is clamped directly. One shot of Custodiol (EUSA Pharma, Limonest, France) is the most commonly used cardioplegia. Aortic valve replacement is performed in the regular way. To reduce the aortic cross-clamping time, sutureless or rapid-deployment valves, as well as the Cor-Knot (LSI Solutions, Inc., Victor, NY, USA) automatic knotting system, are excellent options. Right anterior minithoracotomy for aortic valve replacement is safe and reproducible.