Ascending aorta and aortic valve replacement in circulatory arrest via upper hemisternotomy: a step-by-step video

This video tutorial presents a step-by-step minimally invasive approach to combined aortic valve and ascending aortic replacement using circulatory arrest and antegrade cerebral perfusion. Upper hemisternotomy provides sufficient exposure for complex aortic procedures while reducing surgical trauma compared to full sternotomy. Central arterial inflow is established via innominate artery cannulation using a side graft, enabling selective antegrade cerebral perfusion without an additional axillary incision. Key technical steps include upper hemisternotomy, cannulation strategy, initiation of antegrade cerebral perfusion, distal open anastomosis during circulatory arrest, and subsequent aortic valve replacement with a proximal aortic anastomosis. Emphasis is placed on the perfusion setup, operative technique, and technical details critical to procedural safety. This video tutorial demonstrates that minimally invasive techniques combined with appropriate perfusion strategies can be safely applied to selected aortic procedures requiring circulatory arrest.