Minimally invasive pulmonary valve replacement via left anterior mini-thoracotomy using an automated fastener-assisted suturing technique: a case report.

Chronic pulmonary regurgitation is a late complication after repair of congenital heart disease involving the right ventricular outflow tract. In adult congenital heart disease patients, redo sternotomy carries a risk of cardiac injury due to dense retrosternal adhesions, and minimally invasive approaches have emerged as alternatives. In addition to the surgical approach, prosthetic valve implantation at the posterior pulmonary annulus is technically challenging because knot tying above the valve is difficult in a restricted operative field. We report a 40-year-old man with congenital pulmonary artery dilatation after childhood ventricular septal defect repair who underwent pulmonary valve replacement via left anterior mini-thoracotomy. A 27-mm bioprosthetic valve was implanted in a supra-annular position using interrupted mattress sutures, with an automated knot fastener (Cor-Knot) applied to the posterior annulus. This case demonstrates that minimally invasive pulmonary valve replacement is feasible and reproducible, and that automated fasteners facilitate standard suturing at the posterior pulmonary annulus.