P279. Reimplantation for Calcified Bicuspid Aortic Valve with Our Endoscopic Evaluation Technique
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Kokura Memorial Hospital
Kitakyushu
Japan - Contact Me
Dr. Yuta Kitagata is a dedicated cardiovascular surgeon currently practicing at Kansai Electric Power Hospital. After graduating from Gifu University School of Medicine, Dr. Yuta Kitagata gained invaluable experience working at several hospitals before obtaining board certification in Cardiovascular Surgery in January 2024. With a passion for advancing medical knowledge and patient care, Dr. Yuta Kitagata continues to hone their skills in cardiovascular surgery, actively engaging in academic work and furthering their expertise in the field. Driven by a commitment to excellence, they strive to provide the highest standard of care to their patients while contributing to the advancement of cardiovascular medicine.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Repairing aortic regurgitation in cases involving calcified bicuspid valves remains a complex challenge. This presentation shows a successful repair of a calcified aortic valve through the reimplantation method using an ultrasound device, with the assistance of our developed endoscopic evaluation technique.
Case Video Summary: A 57-year-old male patient was diagnosed with moderate aortic valve regurgitation with fused and calcified right and left coronary cusps, a sinus of Valsalva measurement of 43 mm, and an enlarged ascending aorta measurement of 55 mm. After establishing cardiopulmonary bypass, distal anastomosis with a 28-mm Dacron woven graft right before the brachiocephalic artery and a patent foramen ovale closure via the right atrial were performed during circulatory arrest under hypothermia at a rectal temperature of 25°C. After trimming the aortic root and making coronary buttons, the raphe of the fused cusp was dissected and advanced calcifications were removed using an ultrasound device with attention not to perforate the cusps, which caused the mobility of the fused cusp to be improved. A 28-mm Dacron Valsalva-type graft was fixed to the ventriculo-aortic junction with twelve first-row sutures. After that, the commissure angle was fixed at 180 degrees to improve the mobility of the non-fused cusp, and the center of the fused cusp was resected in a triangular form to remove excess tissue. Our developed endoscopic evaluation method involved inserting a camera port with a balloon at the tip into the graft, inflating the balloon, and adding saline solution through a side tube to provide sufficient monitored pressure to the base. This allowed us to observe the aortic valve from the front using a camera. With a continuously monitored pressure of 70 mmHg applied to the valve, no regurgitation and great coaptation with matched free margins of the cusps were observed. Finally, the second-row suture was performed horizontally with polypropylene, and the shape of the aortic root was fixed. The total operation time was 5 hours and 40 minutes, aortic clamp time was 193 minutes, and circulation arrest time was 23 minutes, with no need for blood transfusion. The patient made a successful recovery and was discharged 10 days after the surgery, and follow-up echocardiography revealed no regurgitation.
Conclusions: In this case, we achieved optimal results by using our endoscopic evaluation method, which is particularly valuable for straightforward front-facing valve assessment under a continuously monitored pressure of 70 mmHg. Furthermore, when treating with bicuspid aortic valves, the cautious removal of calcifications using an ultrasound device can be advantageous in cases with a calcified valve, as calcified areas can impede mobility and complicate the reconstruction process. These techniques not only eliminate regurgitation in calcified valves but also improve valve patency and provide a sufficient effective orifice area.
Authors
Yuta Kitagata (1), Taro Nakatsu (1), ETSURO SUENAGA (1)
Institutions
(1) Kansai Electric power hospital, Osaka, Osaka
Case Video Summary: A 57-year-old male patient was diagnosed with moderate aortic valve regurgitation with fused and calcified right and left coronary cusps, a sinus of Valsalva measurement of 43 mm, and an enlarged ascending aorta measurement of 55 mm. After establishing cardiopulmonary bypass, distal anastomosis with a 28-mm Dacron woven graft right before the brachiocephalic artery and a patent foramen ovale closure via the right atrial were performed during circulatory arrest under hypothermia at a rectal temperature of 25°C. After trimming the aortic root and making coronary buttons, the raphe of the fused cusp was dissected and advanced calcifications were removed using an ultrasound device with attention not to perforate the cusps, which caused the mobility of the fused cusp to be improved. A 28-mm Dacron Valsalva-type graft was fixed to the ventriculo-aortic junction with twelve first-row sutures. After that, the commissure angle was fixed at 180 degrees to improve the mobility of the non-fused cusp, and the center of the fused cusp was resected in a triangular form to remove excess tissue. Our developed endoscopic evaluation method involved inserting a camera port with a balloon at the tip into the graft, inflating the balloon, and adding saline solution through a side tube to provide sufficient monitored pressure to the base. This allowed us to observe the aortic valve from the front using a camera. With a continuously monitored pressure of 70 mmHg applied to the valve, no regurgitation and great coaptation with matched free margins of the cusps were observed. Finally, the second-row suture was performed horizontally with polypropylene, and the shape of the aortic root was fixed. The total operation time was 5 hours and 40 minutes, aortic clamp time was 193 minutes, and circulation arrest time was 23 minutes, with no need for blood transfusion. The patient made a successful recovery and was discharged 10 days after the surgery, and follow-up echocardiography revealed no regurgitation.
Conclusions: In this case, we achieved optimal results by using our endoscopic evaluation method, which is particularly valuable for straightforward front-facing valve assessment under a continuously monitored pressure of 70 mmHg. Furthermore, when treating with bicuspid aortic valves, the cautious removal of calcifications using an ultrasound device can be advantageous in cases with a calcified valve, as calcified areas can impede mobility and complicate the reconstruction process. These techniques not only eliminate regurgitation in calcified valves but also improve valve patency and provide a sufficient effective orifice area.
Authors
Yuta Kitagata (1), Taro Nakatsu (1), ETSURO SUENAGA (1)
Institutions
(1) Kansai Electric power hospital, Osaka, Osaka
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.