Background Surgical incisional approach to the ascending aorta is the main strategic step during valvular and/or subvalvular aortic interventions. Classic aortotomy incisions (transverse or oblique) can be challenging and can cause suboptimal exposure of the aortic root especially for the patients with small aortic annulus or for redo coronary artery bypass patients with patent proximal grafts interposed to the ascending aorta.

Methods The Kırali incision was used in 91 patients (including 13 reoperations) who underwent an aortic intervention for valvular and subvalvular pathologies. Aortic root was exposed by forming inverted “U” shape incision starting from approximately 3 cm above the right coronary ostium toward the center of the noncoronary annulus and the top of the left–right commissure like a tongue.

Results The aortic valve was replaced with a mechanical prosthesis in 45 patients and with a bioprosthesis in 39 patients including 14 sutureless and 16 stentless prostheses. A total of 29 patients received a concomitant procedure per the following: coronary artery bypass grafting on 8 patients and left ventricular assist device on 7 patients. There was no any problem related to aortotomy incision technique such as bleeding, rupture, dehiscence, or laceration perioperatively. There was no complication related to the procedure during 5-year follow-up.

Conclusion This new aortotomy incision technique is a safe procedure that provides good exposure for all kinds of aortic valve interventions and protects grafts and can facilitate aortic root enlargement or aortoplasty easily. This incision has the potential to be an alternative to traditional techniques.

背景 升主动脉的手术切口方法是瓣膜和/或瓣膜下主动脉介入治疗的主要战略步骤。经典的主动脉切开术切口（横向或斜向）可能具有挑战性，并且可能导致主动脉根部暴露不佳，特别是对于主动脉环较小的患者或在升主动脉插入近端移植物的重做冠状动脉搭桥患者。

方法 91 名因瓣膜和瓣膜下病变接受主动脉介入治疗的患者（包括 13 例再次手术）采用 Kırali 切口。从右冠状动脉口上方约 3 cm 开始，向非冠状动脉环中心和左右连合顶部形成像舌头一样的倒“U”形切口，暴露主动脉根部。

结果 45 例患者采用机械瓣膜置换主动脉瓣，39 例患者采用生物瓣膜置换，其中 14 例为无缝线假体，16 例为无支架假体。共有 29 名患者接受了以下伴随手术：8 名患者接受冠状动脉旁路移植术，7 名患者接受左心室辅助装置。围术期未出现出血、破裂、裂开、裂伤等与主动脉切开切口技术相关的问题。5年随访期间没有出现与手术相关的并发症。

结论 这种新的主动脉切开切口技术是一种安全的手术，为各种主动脉瓣介入手术提供了良好的暴露并保护移植物，并且可以轻松地促进主动脉根部扩大或主动脉成形术。这种切口有可能成为传统技术的替代方案。