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Miami Minimally Invasive Valves
Joseph Lamelas, MD
Dedicated to the Advancement of Minimally Invasive Cardiac Surgery
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July 21, 2015
Minimally Invasive Replacement of the Ascending Aorta – New Concept

In some minimally invasive cases where the ascending aorta is replaced at the level of the STJ and the AV is sparred (not a David procedure, a supra-coronary replacement), I find it valuable to use 2 separate grafts. One segment of graft is initially anastomosed to the hemi -arch or the distal ascending aorta and the other segment of graft to the STJ.  These are then beveled and sewn together.  This 2 graft technique is especially helpful if the proximal anastomosis ( STJ) is far away.

 The technique that I have used to suture this proximal anastomosis entails inverting the proximal graft into the root and suturing it with a running suture. Once complete the small segment of graft is pulled from the root and there is a very hemostatic closure. The pictures below demonstrate the technique.

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3 thoughts on “Minimally Invasive Replacement of the Ascending Aorta – New Concept”

  1. The eversion technique has been described long time ago and as you mentioned it is very hemostatic and straight forward technique. I would like to have some information and photos on how you perform the distal anastomosis on the aortic arch.
    Thank you a lot and again congratulations for your achievements
    A.P.

    1. I submitted an article to Innovations on How to Do. Hopefully will be out soon. If you are at the STS meeting in Arizona, I will be presenting a video on the mini acscending aortic surgery.

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