title: Anterior longitudinal aortotomy in aortic valve replacement.
abstract: OBJECTIVE
  We adopted an anterior longitudinal aortotomy in some cases of aortic valve replacement (AVR), and report them here. The potential of this method is also discussed.
  
  
  METHODS
  We analyzed the data on 24 patients (75.5 ± 7.8 years of age) who had undergone AVR through anterior longitudinal aortotomy. The indications for surgery were prosthetic valve complication in 5 patients, aortic stenosis (AS) with left ventricular outflow tract stenosis (LVOTS) in 16 patients, and aortic regurgitation with moderately dilated ascending aorta in 3 patients. The Konno procedure was performed in 6 cases with small aortic annuli. A longitudinal aortotomy was made at the aortic root along the left side of the right coronary ostium, and extended beyond the right coronary annulus to the interventricular septum as needed.
  
  
  RESULTS
  Bioprostheses (21.1 ± 1.7 mm) were used in 23 patients and a 21-mm mechanical valve for one (a 59-year-old man). One high-risk patient died of low output syndrome, leading to a mortality rate of 4.2 %. All other patients recovered well, though atrioventricular block occurred in 2 cases.
  
  
  CONCLUSIONS
  Anterior longitudinal aortotomy provides a good field of vision at the aortic annulus and the flexibility to develop into anterior annular enlargement. Major indications for this approach are small sino-tubular junction and very small aortic annulus. This approach could be an attractive option in AVR for cases of AS with small aortic annuli and LVOTS. It could also be useful for AVR cases with moderately dilated ascending aorta requiring aortoplasty.
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan. matsuzaki@tmch.or.jp.
authors.forename: Kanji
authors.initials: K
authors.lastname: Matsuzaki
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kudo
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ikeda
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Konishi
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Jikuya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures / Q000379:methods*; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000601:surgery
keywords: Anterior longitudinal aortotomy; Aortic valve replacement; Konno procedure; Left ventricular outflow tract stenosis; Small aortic annulus