This is an elderly obese, wheelchair bound patient who had a bleeding disorder and did not qualify for a TAVR. A CT Scan was performed for TAVR screening. When she disclosed the bleeding disorder (hyper-coagulable state), she was turned down. She ultimately had a mini thoracotomy AVR, uneventfully.
I have been told that a contraindication for a mini thoracotomy AVR is if the aorta is displaced to the left side of the chest by CT Scan or lies to the left of an imaginary line drawn from the mid portion of the sternum straight back to the vertebral column. I believe that this is definitely NOT the case.
The mini AVR in this particular obese patient, with a “left sided” aorta, was extremely easy. I would venture to say that I have had very skinny patients with the aorta lying just underneath the sternum to be the more challenging cases.
I have provided intra operative pictures of the exposure as well as the CT Scan for you to be the judge of this falsely claimed contraindication.