{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T04:03:45Z","timestamp":1748491425361,"version":"3.41.0"},"reference-count":0,"publisher":"European Association of Cardiothoracic Surgery (EACTS Publishing Ltd)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MMCTS"],"published-print":{"date-parts":[[2025,5,28]]},"abstract":"<jats:p>Periareolar incision for endoscopic aortic valve replacement via the 9-suture technique\nFemoral Vessel Exposure\n\u2022\tIncision above the groin crease reduces complications.\n\u2022\tPartial vessel exposure (no full isolation) with purse-string sutures (4\/0 Prolene for vein, pledgeted 5\/0 Gore-Tex for artery).\nSurgical Access\n\u2022\tPeriareolar incision (third intercostal space): muscle-sparing, hidden scar, Alexis retractor for exposure.\n\u2022\tLeft ventricular vent (fifth intercostal space): CO\u2082 insufflation (2 L\/min) to prevent air embolism.\n\u2022\tCamera port (third intercostal space: for visualization and retraction).\nFemoral Cannulation\n\u2022\tSeldinger\u2019s technique under transoesophageal echocardiography guidance; venous cannula to the superior vena cava (vacuum-assisted), artery.\nPericardiotomy and Clamp Placement\n\u2022\tIncision anterior to phrenic nerve; stay sutures for exposure.\n\u2022\tChitwood clamp inserted via second intercostal space to stabilize the aorta.\nCardioplegia and Aortotomy\n\u2022\tAntegrade Custodiol cardioplegia via 3-0 Prolene purse-string suture.\n\u2022\tHorizontal aortotomy after cross-clamping.\nValve Excision and Suture Placement (9-Suture Technique)\n\u2022\tValve excised; annulus decalcified.\n\u2022\tPledgeted horizontal mattress sutures (3 commissural, 2 per cusp) placed strategically.\nValve Implant and Closure\n\u2022\tSutures passed through the prosthetic valve, parachuted, secured with Cor-Knot.\n\u2022\tAortotomy closed in two layers (pledgeted mattress + running suture).\nDe-airing and Weaning\n\u2022\tTrendelenburg, left ventricle vent suction, isolated lung ventilation.\n\u2022\tPacing wires placed; pericardium closed.\nChest Drain and Closure\n\u2022\tDrains inserted; femoral cannulae removed post-heparin reversal.\n\u2022\tPeriareolar incision closed with muscle suture for cosmesis.\nOutcome\n\u2022\tNo paravalvular leak, early extubation (2 h), discharge by postoperative day 4.\n\u2022\tCosmetic advantage, less pain, faster recovery versus sternotomy.\n\u2022\tReduced suture count lowers left ventricular outflow tract gradients without increasing leak risk.<\/jats:p>","DOI":"10.1510\/mmcts.2025.031","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T10:20:14Z","timestamp":1748427614000},"source":"Crossref","is-referenced-by-count":0,"title":["Scarless aortic valve replacement (periareolar approach) with a limited suture technique"],"prefix":"10.1510","member":"10966","published-online":{"date-parts":[[2025,5,28]]},"container-title":["Multimedia Manual of Cardio-Thoracic Surgery"],"original-title":[],"deposited":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T10:20:14Z","timestamp":1748427614000},"score":1,"resource":{"primary":{"URL":"https:\/\/mmcts.org\/tutorial\/2023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,28]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1510\/mmcts.2025.031","relation":{},"ISSN":["1813-9175"],"issn-type":[{"value":"1813-9175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,28]]}}}