SURGEONS have not yet developed a safe approach to the aortic valve. Previous attempts have been reported by Bailey and co-workers,* Brock,3 and Niedner.7 Bailey and others,2 in an excellent review of the subject of aortic stenosis, gives a full account of the methods used to date in reaching the aortic valve by himself and others.
Both the ventricular and the aortic routes are hazardous because of conditions peculiar to the tissues traversed. With surgical trauma the ventricle tends to fibrillate; in aortic stenosis the intraventricular pressures are extremely high, and the hypertrophied myocardium may be unable to hold closing sutures. The proximal aortic wall has poor strength and elasticity. It will bleed alarmingly from fine needle holes, will tear easily rather than stretch, and may fail to hold sutures placed for hemostatis during ventricular entry. After due study we chose to develop the aortic approach. In