Different valve types: tips and tricks for a totally endoscopic aortic valve replacement

Endoscopic aortic valve replacement is a fascinating and rapidly growing surgical activity. In the setting of minimally invasive surgical procedures, compared with mitral and tricuspid procedures, aortic valve operations increase the challenge for several reasons. If one relies only on the thoracoscope, the surgical planning and set-up, including the placement of the working port and technical surgical manoeuvres like the aortic cross-clamp, the aortotomy and the aortorrhaphy can be difficult and may lead to severe complications or an increased rate of conversion to sternotomy. A well-developed preoperative decision-making process that includes knowledge of the prosthetic valve characteristics and their implications in an endoscopic environment is crucial for a successful endoscopic aortic valve programme. This video tutorial provides tips and tricks useful for endoscopic aortic valve replacement by paying attention to the patient's anatomy, to the available prosthetic valve types and to their impact on the surgical set-up.