[HSF] elective replacement of tissue valve

[Hgrmd at aol.com]

Michael,
  Whenever I have to repair a mitral in the presence of a well  functioning 
aortic prosthesis, I generally approach it through the superior  septal 
incision.  Currently, that's about the only time I still use that  incision, since it 
is associated with a higher incidence of conduction  abnormalities.  This 
approach, however, generally provides adequate access  to the anterior mitral 
annulus, even in the presence of a rigid aortic  prosthesis.
  Now that I have a robotic endoscopic platform, the next time I get  such a 
case, I will be tempted to do the case through this approach.  The  camera and 
service ports are quite lateral, so it's a straight shot to the  mitral.  
I've already done a couple of redos with this approach.  Not  easy, but 
definitely doable.
 
Hal



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