Exposure of the mitral valve by transecting the ascending aorta during aortic and mitral valve replacement

Combined Valve Operations with Transection of Ascending Aorta

“…With complete transection of the aorta and forward traction on its proximal end, the plane of the aortic annulus is parallel to that of the operative field, giving very good exposure of the valve. 1,2 A similar approach was reported by Machiraju and colleagues 3 who had satisfactory results. The mitral valve could be exposed well in all of our patients, and the extra “T” incision mentioned by Machiraju and colleagues 3 was not employed in our series.…”

“…1,2 A similar approach was reported by Machiraju and colleagues 3 who had satisfactory results. The mitral valve could be exposed well in all of our patients, and the extra "T" incision mentioned by Machiraju and colleagues 3 was not employed in our series. We found that if an adequately long atrial incision was made, good mitral valve exposure was achieved, regardless of a small or large left atrium.…”

“…Several strategies have been employed to improve exposure, including retracting the venae cavae, extending the transseptal approach, and transecting the superior vena cava or the azygos vein. 3 For an isolated mitral valve operation, any of these methods can facilitate exposure, but sometimes give rise to problems. As the ascending aorta is situated in front of the heart and relatively immobile, it is the main obstacle to good visualization of the mitral valve.…”