Endoscopic evaluation technique using a camera port for valve-sparing root reconstruction

• Published in: Interdisciplinary cardiovascular and thoracic surgery Vol. 36; no. 3
• Main Authors: Kawasaki, Yusuke, Suenaga, Etsuro, Nakatsu, Taro, Minatoya, Kenji
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 02.03.2023
• Subjects: Valvular Heart Disease; Valve-sparing root reconstruction; Balloon blunt-tip system; Aortic valve evaluation
• ISSN: 2753-670X; 2753-670X
• DOI: 10.1093/icvts/ivad039

Abstract Intraoperative aortic valve evaluation should be accurate in valve-sparing root replacement to minimize postoperative aortic valve regurgitation. Ascending aorta de-clamping and weaning of cardiopulmonary bypass are required in intraoperative transoesophageal echocardiography. Aortic valve endoscopy aids in the magnification of structures and enables image sharing within the operative team. While a rigid endoscope and saline infusion line are directly inserted from the Valsalva graft end, a Kelly clamp is needed for graft gap closure, affecting the valve morphology due to graft deformation. The accurate inner pressure of the neo-Valsalva sinus cannot be measured in this method. We propose a technique to accurately evaluate aortic valve conformation using a balloon blunt-tip system that enables aortic valve evaluation under the measured pressure and without Valsalva graft deformation. Valve-sparing root replacement is advantageous over the Bentall technique and provides excellent long-term results [1].