P360. Two staged evaluations for aortic root reimplantation using BBT endoscopic system
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Kansai Electric power hospital
Osaka, Osaka
Japan - Contact Me
Etsuro Suenaga is the chief of the Department of Cardiovascular Surgery at Kansai Electric Power Hospital in Japan. He is well versed in cardiovascular surgery and has performed many surgeries over a long period of time, especially in minimally invasive cardiac surgery.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
Authors
ETSURO SUENAGA (1), Taro Nakatsu (2), Yuta Kitagata (3)
Institutions
(1) Kansai Electric power hospital, Osaka, Osaka, (2) N/A, Japan, (3) N/A, N/A
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.
Authors
ETSURO SUENAGA (1), Taro Nakatsu (2), Yuta Kitagata (3)
Institutions
(1) Kansai Electric power hospital, Osaka, Osaka, (2) N/A, Japan, (3) N/A, N/A
Presentation Duration
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