Truly stentless autologous pericardial aortic valve replacement: An alternative to standard aortic valve replacement K.M. John Chan, BMedSci (Hons),

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Presentation transcript:

Truly stentless autologous pericardial aortic valve replacement: An alternative to standard aortic valve replacement K.M. John Chan, BMedSci (Hons), BMBS, MSc, FRCS CTh, Shelley Rahman-Haley, MB BCh, MD, MRCP, Tarun K. Mittal, MD, FRCR, Jemyrr A. Gavino, BSN, MPH, Gilles D. Dreyfus, MD The Journal of Thoracic and Cardiovascular Surgery Volume 141, Issue 1, Pages 276-283 (January 2011) DOI: 10.1016/j.jtcvs.2010.09.038 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Construction of the autologous pericardial aortic valve using CardioMend instruments. A, The sinotubular junction is sized using sizers ranging in size from 19 to 27 mm. B, The harvested autologous pericardium is placed on a base. C, The cutter blade of the appropriate size is placed over the autologous pericardium to cut it to the required size and shape. D, The cut pericardium before removal of the unwanted pieces. Any loose tissue is cut off with a roller cutter. E, The trefoil of cut pericardium is shown after removal of the unwanted pieces. F, The cut pericardium is placed on the tissue holder ready to be sutured to the aortic wall. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 276-283DOI: (10.1016/j.jtcvs.2010.09.038) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Figures showing construction of the new aortic valve using the preshaped autologous pericardium. A, The noncoronary cusp leaflet has been sewn in using continuous 4–0 Prolene polypropylene sutures. The commissural sutures are shown, which pass through the wall of the aorta from inside to outside where the suture is tied. B, All 3 aortic leaflets have been sutured in. The coaptation between the valve leaflets is shown and the symmetry of the reconstructed valve leaflets is demonstrated. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 276-283DOI: (10.1016/j.jtcvs.2010.09.038) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Histologic examination of the autologous pericardial valve explanted at 15 months owing to a technical failure showing preservation of the normal collagen structure of the autologous pericardium with no calcification. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 276-283DOI: (10.1016/j.jtcvs.2010.09.038) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Series of cardiac magnetic resonance images demonstrating the normal function and geometry of the reconstructed autologous pericardial aortic valve in a patient 6 years after the operation. A and B, Left ventricular outflow tract and ascending aortic views in diastole demonstrating normal coaptation between the valve leaflets and no regurgitation. C, Transverse aortic valve view in diastole demonstrating coaptation between the valve leaflets and its symmetrical trileaflet geometry. D, E, and F, Corresponding images in systole showing normal symmetrical opening of the reconstructed aortic valve leaflets. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 276-283DOI: (10.1016/j.jtcvs.2010.09.038) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions