Ct-guided Aortic Valve Neocuspidization Combined With Coronary Artery Bypass Grafting
Borys Todurov, Igor Mokryk, Bohdan Batsak, Nataliya Ponych.
Heart Institute, Kyiv, Ukraine.
OBJECTIVE: Technique of Aortic Valve Neocuspidization (AVNeo) permits valve implantation with excellent immediate- and mid-term hemodynamic result. One of the drawbacks is prolonged ischemic time as leaflets are measured and prepared during cross-clamp. With a method we present cusps are measured on distended aorta and prepared for implantation before initiation of bypass.
METHODS: Patient is 71-year old male. Height 169 cm; Weight 90 kg. Symptoms: dyspnoea and retrosternal pain on exertion. EchoCG: Bicuspid Aortic Valve; mean gradient 69 mm Hg; moderate Aortic Insufficiency; AV orifice area 0.7 cm2; Aortic Annulus 22 mm; LV EF 50%. Coronary angiography: three-vessel coronary artery disease. Patient was qualified for surgery: CT-guided AVNeo with CABG (LIMA to LAD; SVG to OM1 and PDA). Preoperatively a contrast CT-scanning of the thoracic aorta was performed and 3-D model of Aortic Root was developed. Measurements where taken and personalized templates of each AVNeo leaflet where prepared.
RESULTS: All cusps where feasible for implantation into respective parts of the aortic anulus, according to technique described by Ozaki. Aortic cross-clamp time 108 min; bypass time 151 min. Postoperative period was uneventful: ICU stay 2 days; Postoperative hospital stay 7 days. EchoCG control after 1 month postoperatively: trace AI with transvalvular gradient 12/7 mm Hg. MRI control demonstrated good mobility and coaptation of autopericardial cusps
CONCLUSIONS: CT-guided AVNeo preserves optimal hemodynamic characteristics of original Ozaki technique. At the same time it has important advantages over standard AVNeo: 1) It significantly shortens ischemic time as leaflets are measured and prepared before initiation of bypass. 2) Measurements are taken on distended aorta providing for maximally accurate and personalized planning of the procedure. This is especially important in patients with uni- and bicuspid valves, small aortic annulus and children. 3) 3-pledget technique provide optimal additional support for neocommissures.
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