Aortic Valve Replacement Through a Minimally Invasive Approach: Preoperative Planning, Surgical Technique, and Outcome Andre Plass, MD, Hans Scheffel,

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Aortic Valve Replacement Through a Minimally Invasive Approach: Preoperative Planning, Surgical Technique, and Outcome Andre Plass, MD, Hans Scheffel, MD, Hatem Alkadhi, MD, PhD, Philipp Kaufmann, MD, PhD, Michele Genoni, MD, PhD, Volkmar Falk, MD, PhD, Jürg Grünenfelder, MD, PhD The Annals of Thoracic Surgery Volume 88, Issue 6, Pages 1851-1856 (December 2009) DOI: 10.1016/j.athoracsur.2009.08.015 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) A 6-cm incision (6 cm) is placed in the intercostal space of the right-sided chest wall and (B) a soft-tissue retractor and rib spreader are used for the minithoracotomy. The Annals of Thoracic Surgery 2009 88, 1851-1856DOI: (10.1016/j.athoracsur.2009.08.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Venous cannulation in the groin is achieved under (B) echocardiographic navigation. (C) Arterial cannulation and aortic clamping are done directly through the thoracotomy. The Annals of Thoracic Surgery 2009 88, 1851-1856DOI: (10.1016/j.athoracsur.2009.08.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Preoperative planning variables at multislice computed tomography imaging include (A) distance measurements from the intercostal space to the next aortic spot, aortic annulus, and right internal thoracic artery, (B) length of the aorta for cannulation, and (C) diameter evaluation for the aortic annulus. The Annals of Thoracic Surgery 2009 88, 1851-1856DOI: (10.1016/j.athoracsur.2009.08.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Multislice computed tomography imaging for the detection of a calcified plaque in the aortic arch (arrow) is shown in a (A) 3-dimensional and (B) 2-dimensional illustration. The Annals of Thoracic Surgery 2009 88, 1851-1856DOI: (10.1016/j.athoracsur.2009.08.015) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions