Minimally invasive root surgery: a Bentall procedure through a J-ministernotomy

Clinical vignette A 43-year-old woman was referred to our hospital with a diagnosis of severe aortic regurgitation and ascending aorta aneurysm (Video 1). The patient was classified as New York Heart Association (NYHA) II. Upon admission, a transthoracic echocardiogram showed a bicuspid aortic valve associated with severe aortic regurgitation and normal left ventricular function [left ventricular ejection fraction (LVEF) =65%]. The computed tomography (CT) angiogram confirmed dilatation of the sinuses of Valsalva (42 mm) and ascending aorta (45 mm). Coronary angiography ruled out any significant coronary artery disease. The patient was scheduled for a Bentall procedure through an upper J-ministernotomy (1).