P218. Mini-access Root Reimplantation Using Modified Suture Technique
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Asan Medical Center
Seoul
South Korea - Contact Me
After several years of fellowship, Min Jung is developing her capabilities as a thoracic surgeon in the adult cardiac surgery department.
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Education:
- Daegu Hanny University (Herbal Medicine), Mar. 2004 – Feb. 2008
- Jeju National University School of Medicine, Mar. 2010 – Feb. 2015
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Professional Experiences:
- Internship and Residency in Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Mar. 2015 – Feb. 2020
- Clinical Fellow in Cardiac Surgery, Samsung Medical Center, Mar. 2020 – Feb. 2022
- Continuing as Clinical Fellow in Cardiac Surgery, Asan Medical Center, Mar. 2022 – Feb. 2024
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objectives: Valve-sparing aortic root replacement (VSARR) offers many advantages over complete root replacement by avoiding the systemic anticoagulation and the prosthetic-valve related complications. Root reimplantation, mostly widely accepted prototype procedure in VSARR, however, may entail some technical difficulties when the second-layer hemostatic stitches are made by conventional over-and-over continuous sutures within the woven-polyester graft especially for the beginning-level surgeons. We would like to show "Half Back Stitch" technique for the hemostatic suture line during the root reimplantation for VSARR.
Case Video Summary: The cardiac arrest is induced with cardioplegic solution infusion after an aortic clamp placement. The aorta wall is resected leaving its margin of around 3mm, coronary buttons are trimmed, and the root is completely mobilized. Graft diameter is determined, usually 28mm to 32mm, based on the length of free-edge of the cusp, in which the diameter should be shorter than the free-edge length so that the cusps can make coaptation point at the center of the graft. Non-pledgeted 6 sub-annular stitches with 2-0 braided polyester are placed using horizontal mattress sutures, which are then fixed at the bottom of graft. Standard manner, thereafter, is to make hemostatic layer stitches to reattach the native aortic valve (AV) annulus inside the tubular graft using continuous over-and-over sutures referred as "whip stitch technique" in the classic root reimplantation (Figure 1A). We, however, have adopted modified version of this attachment sutures-"half back stitch" (Figure 1B). At first, the inside-out suture is performed at the nadir of AV annulus, and it is tied down outside of the graft. The next suture proceeds outside-in manner 3mm proximal to the first suture. Then, the return suture goes inside-out way 10mm distal to the prior suture. After repeating this "half back stitch", the thread is tie down outside of the graft at the commissure level. By repeating the three sets of this continuous suture for each of the sinus, hemostatic layer is completed (Figure 2). When the leaflet prolapses, the central plication suture is added to elevate the coaptation of the corresponding leaflet. Thereafter, the coronary buttons are reattached to the graft. Finally, the distal part of the graft is anastomosed to the native aorta or another artificial graft depending on the extent of distal repair.
Conclusions: "Half back stitch" involves a straightforward penetration of each stitch as the suture line only exist in the overlapping area of native aortic rim and graft. It may offer more stable hemostasis as it makes reinforced layers of suture lines. By the addition of small backward stitch on each large forward stitch, it may also prevent purse-string effects of the suture lines. We believe that these advantages may shorten the cardiac ischemic time and may help construct the hemostatic suture lines. In summary, the "half back stitch" technique is technically easy and may be helpful for the timesaving and better hemostasis during the VSARR.
Authors
MInJung Ku (1), Joon Bum Kim (2), Wan Kee Kim (3), Hong Rae Kim (4)
Institutions
(1) N/A, N/A, (2) Asan Medical Center, Seoul, Na, (3) Yongin Severance Hospital, Yongin, Gyeonggi-do, (4) Asan Medical Center, Gangnamgu, Seoul
Case Video Summary: The cardiac arrest is induced with cardioplegic solution infusion after an aortic clamp placement. The aorta wall is resected leaving its margin of around 3mm, coronary buttons are trimmed, and the root is completely mobilized. Graft diameter is determined, usually 28mm to 32mm, based on the length of free-edge of the cusp, in which the diameter should be shorter than the free-edge length so that the cusps can make coaptation point at the center of the graft. Non-pledgeted 6 sub-annular stitches with 2-0 braided polyester are placed using horizontal mattress sutures, which are then fixed at the bottom of graft. Standard manner, thereafter, is to make hemostatic layer stitches to reattach the native aortic valve (AV) annulus inside the tubular graft using continuous over-and-over sutures referred as "whip stitch technique" in the classic root reimplantation (Figure 1A). We, however, have adopted modified version of this attachment sutures-"half back stitch" (Figure 1B). At first, the inside-out suture is performed at the nadir of AV annulus, and it is tied down outside of the graft. The next suture proceeds outside-in manner 3mm proximal to the first suture. Then, the return suture goes inside-out way 10mm distal to the prior suture. After repeating this "half back stitch", the thread is tie down outside of the graft at the commissure level. By repeating the three sets of this continuous suture for each of the sinus, hemostatic layer is completed (Figure 2). When the leaflet prolapses, the central plication suture is added to elevate the coaptation of the corresponding leaflet. Thereafter, the coronary buttons are reattached to the graft. Finally, the distal part of the graft is anastomosed to the native aorta or another artificial graft depending on the extent of distal repair.
Conclusions: "Half back stitch" involves a straightforward penetration of each stitch as the suture line only exist in the overlapping area of native aortic rim and graft. It may offer more stable hemostasis as it makes reinforced layers of suture lines. By the addition of small backward stitch on each large forward stitch, it may also prevent purse-string effects of the suture lines. We believe that these advantages may shorten the cardiac ischemic time and may help construct the hemostatic suture lines. In summary, the "half back stitch" technique is technically easy and may be helpful for the timesaving and better hemostasis during the VSARR.
Authors
MInJung Ku (1), Joon Bum Kim (2), Wan Kee Kim (3), Hong Rae Kim (4)
Institutions
(1) N/A, N/A, (2) Asan Medical Center, Seoul, Na, (3) Yongin Severance Hospital, Yongin, Gyeonggi-do, (4) Asan Medical Center, Gangnamgu, Seoul
Presentation Duration
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