Several reports have been published recently detailing less invasive techniques for cardiothoracic surgical procedures designed to limit surgical trauma while decreasing costs] After our initial successful experience with minimally invasive video-assisted coronary surgery >4 and minimally invasive video-assisted mitral valve replacement, s which followed the first report of video-assisted mitral valvuloplasty by Carpentier and associates, 6 we performed two cases of minimally invasive aortic valve replacement with a new technique.Clinical summaries PATIENT 1. A 63-year-old male patient was admitted in July 1996 with severe calcific aortic stenosis, chronic obstructive pulmonary artery disease, and New York Heart Association class IV symptoms. The patient was placed on the operative table in the 30-degree left lateral decubitus position with the right arm elevated above the head. A 6 cm incision was made in the third intercostal space (Fig. 1), and a specially adapted wound spreader (Access Platform, CardioThoracic System, Inc., Portola Valley, Calif.) was secured in place and gently opened to avoid rib fractures. The pericardium was opened on the lateral side exposing the aortic root, the right atrium, and the right superior pulmonary vein (RSPV). To improve the exposure, we supplied several stay sutures at the edges of the pericardial opening and fixed them to the skin. The right femoral artery and the right atrium were cannulated. A vent was inserted in the RSPV. After cardiopulmonary bypass (CPB) was established, the aorta was crossclamped and crystalloid cardioplegic solution was infused in the aortic root. A transverse aortotomy was performed and three stitches were placed in the commissures and pulled upward to expose the anulus. A 21 mm mechanical prosthesis was implanted with single Cardioflon sutures (Peters Laboratories, France). The aortotomy was then closed with a polypropylene running suture, and the air was evacuated through the aortic root and the RSPV vent. Perfusion time was 85 minutes and crossclamp time was 70 minutes. The patient was extubated 24 hours after the operation and discharged on postoperative day 6. The postoperative course was uneventful.PATIENT 2. A 52-year-old male patient was admitted in July 1996 with severe aortic regurgitation and New York Heart Association class IV symptoms. The patient was

This access produces an operative view adequate to safely perform aortic valve surgery. Therefore, removal of ribs or cartilage fragments is not necessary, which results in a less traumatic and less painful approach. Within this is a potential good approach for patients with sternal problems (radiation), redo in certain situations (example previous coronary surgery with LIMA open to LAD). Young patients are potential candidates for future coronary surgery as well as patients with long thoracic cavity and deep aortic plane.

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The Trellis system is effective for rapid lysis of thrombotic emboli using low doses of lytic agents. The unique design of the Trellis allowed complete aspiration of the residual thrombus, thus avoiding adverse effects.

The Trellis system is effective for rapid lysis of thrombotic emboli using low doses of lytic agents. The unique design of the Trellis allowed complete aspiration of the residual thrombus, thus avoiding adverse effects.