Results:
A 60-year-old male with enterococcus faecalis
bacteremia, mitral valve
endocarditis, and very large mobile mass on the mitral valve underwent
minimally invasive mitral valve replacement with 29 mm Magna Ease
pericardial valve via right mini-thoracotomy (RMT). Due to severe
atherosclerosis in the iliofemoral vessels, direct aortic access was
needed through the chest. Two purse-string stitches were placed in the
standard fashion through the RMT incision and then pulled out of the
chest through a 12-mm port placed in the second intercostal space. Using
the Seldinger technique, a guidewire was introduced into the distal
ascending aorta within the pursestring via a needle placed through the
RMT. The wire was also pulled out through the port. After serial
dilation over the wire, a 20-French cannula was advanced into the aortic
arch and secured to the purse-string sutures. TEE confirmed the position
of the wire and cannula in the aortic arch. Cardiopulmonary bypass was
initiated and antegrade cardioplegia catheter was placed in the
ascending aorta. Surgery proceeded in the usual fashion. After excising
the infected valve, a 29 mm pericardial valve was implanted using
Cor-Knot device. After de-airing, aortic root vent was removed and the
site was secured with a Cor-Knot (Figure 1A and 1B). The patient was
weaned off cardiopulmonary bypass. Aortic cannula was removed and the
aortotomy purse-string sutures were secured separately with two
additional Cor-Knots through the port under vision (Figure 2). There was
no bleeding from the cannulation or the root vent site. Patient was
discharged from hospital in 15 days after undergoing femoral-to-femoral
bypass and iliofemoral endarterectomy for lower extremity ischemia on
post-op day 8.