In my quest to facilitate and simplify minimally invasive, right mini-thoracotomy aortic valve surgery over the past 11 years, I have tried many different techniques and devices.

I believe that the aortic cuff  (Miami Instruments, Miami, FL) significantly facilitates and improves the exposure necessary to perform an expeditious and safe operation.

I am constantly asked how is it that I insert the aortic cuff. Due to this, I have decided to make a short You tube video. This is the current and most effective way to insert the cuff.

Of note, patients that have a heavily calcified aortic root may not be good candidates for insertion of the cuff. The cuff needs a semi compliant aorta in order for it to expand inside the root.

There may also be difficulty with insertion of the cuff in patients with a bicuspid aortic valve.  In these patients, with fusion of the left and right cusps, I will place the cuff through the commissural stay suture between the left and right cusp. (Normally it will be placed through the suture between that left and non-coronary cusps). This is not always perfect but does help. If the cuff slips in these cases, I will remove it.

There are also a small group of patients who can have the procedure performed without a cuff because visibility is adequate.

Insertion of Aortic Cuff  (you can click this link or copy and paste the link below)

Over the years I have modified my technique for inserting the post for the atrial lift system.  Believe it or not,  patients were complaining about pain from this insertion site more than from the mini thoracotomy incision.

In the past I was making a small incision in the chest where I wanted to insert the post and thereafter passed a tonsil clamp from the incision and into the chest. I would then take a red rubber catheter , place it through the thoracotomy incision and pull it out through the small incision.  I would then use the red rubber catheter to guide the post back into the chest and later attach it to the blade.  I think that maybe the insertion of the clamp was just too traumatic.

Please view this short video to see the new technique that I strongly recommend.  I have provided the link below. (When you view it,  click on settings, which is the little pin wheel on the lower bar, third from the right.  This is the settings button. Click Quality and the select 720 HP. The resolution will be better)

If anyone has any suggestions or a better way, I would appreciate any comments.