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3d Holographic Virtual Reality Imaging Evaluation Ofaortic Valveleafletreconstruction Using Three Same-sized Aulogous Pericardial Cusps
Takeo Tedoriya1, Tadamasa Miyauchi1, Kenji Okada2, Takanori Tujimoto2.
1Ageo Central General Hospital, Ageo, Japan, 2Kobe University, Department of Cardiovascular Surgery, Kobe, Japan.

OBJECTIVE: Purpose: Aortic valve leaflet reconstruction using three same-sized autologous pericardium leaflets (ATLAS) has been performed for strictly selected patients. We evaluated outcomes of ATLAS with 3D holographic VR image.METHODS:Basic technique; 1) three same-sized leaflets were tailored to original templates referred by STJ diameter, 2) the new commissures and nadirs were confirmed based on 3D-VR image, 3) leaflets were sutured on the cusp-suture line, 4) commissure coaptation stitches were placed to prevent from minor leakage. Enrolled patients underwent ECG-triggered cardiac CT. Thin-sliced axial images were obtained during mid-to-end diastole. Subtracted volume rendering CT data were converted to the workstation to obtain 3D-VR image for assessment of pre- and post-operative valve structure.Periodic echocardiography was performed postoperatively, to evaluate function of reconstructed aortic valve leaflets.RESULTS: From 2015, we have performed ATLAS in 42 patients (AS=14, AR=28). In 17 patients, we performed additional annular adjustment procedures. One patient died after 2 months due to sepsis of preoperative active IE. One redo AVR was done due to perforation of leaflet. 3D-VR image revealed three well-balanced leaflets configuration after ATLAS. Echocardiographic evaluation revealed no AR more than mild, and mean AVPG was 8.6mmHg after the surgery, and8.8mmHg in 6 years.
CONCLUSIONS: ATLAS can provide anatomical physiologic correction of the aortic valve. 3D-VR analysis was useful for preoperative information of the aortic root to accomplish ATLAS, as well as to evaluate reconstructed aortic valve. The short- and mid-term outcomes after ATLAS were acceptable with excellent hemodynamic conditions with well-balanced three leaflets.


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