Totally 3-dimensional endoscopic ventricular septal defect closure and aortic valve replacement via a periareolar incision.

There are no prior reports of totally endoscopic minimally invasive cardiac surgery for combined ventricular septal defect closure and aortic valve replacement. We utilized a periareolar incision as the main access, inserting a cardioplegia line, vent tube and the aortic cross-clamp entirely through this incision. Only three ports (main incision, camera port and left-hand port) were used. A three-dimensional endoscope facilitated precise techniques. The type I ventricular septal defect was approached and closed from the aortic side using a Gore-Tex patch, with mattress sutures for the lower edge and shared sutures with the aortic valve replacement for the upper edge. A stented bioprosthetic valve was sewn in a supra-annular position. The patient recovered rapidly, with excellent cosmetic results and minimal invasiveness.