An intraoperative test device for aortic valve repair

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Presentation transcript:

An intraoperative test device for aortic valve repair Ignacio G. Berra, MD, Peter E. Hammer, PhD, Sebastian Berra, Alfredo Oscar Irusta, Seok Chang Ryu, Douglas P. Perrin, PhD, Nikolay V. Vasilyev, MD, Carlos Javier Cornelis, MD, Pablo Garcia Delucis, MD, Pedro J. del Nido, MD The Journal of Thoracic and Cardiovascular Surgery Volume 157, Issue 1, Pages 126-132 (January 2019) DOI: 10.1016/j.jtcvs.2018.07.113 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 The aortic valve pressurization device consists of a pressurization chamber that is secured inside the transected aorta, a working chamber through which an endoscope is introduced, and side ports for delivering pressurized perfusate and introduction of measurement gauges. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Leaflet coaptation can be measured using a gauge consisting of a thin metal rod with a 1-cm diameter disk at one end. A plastic tube covers the rod and can be slid along it. Starting with the tube completely covering the rod and the disk pulled flush with the ventricular surface of the closed valve (A), the tube is pulled back until its distal end is just visible above the free edges of the coapted leaflets (B). The coaptation height can be measured at the proximal end of the gauge as the distance from the end of the rod to the end of the tube (dimension shown in green). Starting with the tube completely covering the rod and the disk pulled flush with the ventricular surface of the closed valve (C), the tube is pulled back until its distal end is just visible above the free edges of the coapted leaflets (D). The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Endoscopic view of normal aortic valve under diastolic conditions showing leaflet coaptation near the valve center and a normal pattern of collagen fiber bundles. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Endoscopic view showing porcine model of aortic regurgitation in which the right coronary sinus and leaflet have been surgically reduced. We then repaired the valve by plicating a portion of the left coronary sinus, and we measured central coaptation length in the repaired valve using the flexible plastic scale. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Endoscopic view showing porcine aortic valve that has been reconstructed by replacing all 3 leaflets with grafts cut from bovine pericardium. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Aortic valve pressurization device. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 1 This animation shows positioning of the device in the transected aorta, insertion of endoscope through the device, pressurization of the device chamber and valve root with crystalloid solution, and introduction of a gauge for measuring valve coaptation height. Video available at: https://www.jtcvs.org/article/S0022-5223(18)32820-4/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2019 157, 126-132DOI: (10.1016/j.jtcvs.2018.07.113) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions