Two staged evaluations for aortic root reimplantation using BBT endoscopic system

P0360 

Case Video Submission 

ETSURO SUENAGA (1), Taro Nakatsu (2), Yuta Kitagata (3)

(1) Kansai Electric power hospital, Osaka, Osaka, (2) N/A, Japan, (3) N/A, N/A

ETSURO SUENAGA    -  Contact Me
Kansai Electric power hospital

Taro Nakatsu    -  Contact Me
N/A

Yuta Kitagata    -  Contact Me
N/A

ETSURO SUENAGA    -  Contact Me
Kansai Electric power hospital

Objective：Valve-sparing root replacement is advantageous over the Bentall technique and provides excellent long-term results. Intraoperative aortic valve evaluation should be accurate in valve-sparing root replacement for longtime valve durability. We had published a technique to accurately evaluate aortic valve conformation using a balloon blunt-tip(BBT) system that enables aortic valve evaluation under the suitable pressure and without Valsalva deformation. The BBT system is a camera port used for laparoscopic surgery. With a balloon at the tip and a movable soft-gel cone, it is used for Valsalva graft closure with the endoscope placed at the center of the graft. This system has a stopcock that enables objective root pressure monitoring. Using this technique, we have 2 times chance to correct the aortic root, at first adjust commissure height, 2nd leaflet correction.
Case Video Summary: A 69-year-old man, diagnosed with severe aortic regurgitation (AR), was referred to our hospital for operation. Preoperative echocardiography revealed severer AR with Left Ventricular (LV) dilatation. Echocardiography revealed severe AR. A dilated aortic root and ascending aorta were observed on four-dimensional computed tomography angiography. After establishing cardiopulmonary bypass, an aortic cross-clamp was placed to induce cardiac arrest. A 26-mm J-graft Valsalva (Japan Lifeline, Tokyo, Japan) was selected. After ascending aortic replacement, the root reconstruction was resumed. After placing the Valsalva graft with first row stiches, we evaluated the aortic valve using the BBT system to determine the commissure height. The second BBT check was performed after 2nd raw running stitches. Saline was infused into the graft to achieve a 70-mmHg pressure. The aortic valve was corrected with central plication. Finally, intraoperative transesophageal echocardiography revealed no residual AR. The patient discharged hospital uneventfully 9dyas after the operation. Postoperative 4DCT revealed excellent results.
Conclusions: The BBT system facilitates simple and accurate physiological evaluation for valve-sparing root replacement. Using this technique, long-term durable aortic root replacement could be performed.

Aortic Root