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Aortic Homograft New Implantation Technique Through A Ministernotomy Aproach
Miklós Bitay, Ali Shadmanian, Kosha Patel, Petra Fehér, István Gecse, Szilárd Szűcs.
University of Szeged, Szeged, Hungary.

OBJECTIVE:The aortic homograft has very good hemodynamics and long interval of freedom from reintervention (15-20 years), without need of anticoagulant therapy.
We present a new technique for the subaortic homograft implantation performed through an arrow-shaped ministernotomy approach.
METHODS:Between 2001 and 2019, 41 patients received aortic homografts with the new subcoronary technique, the last 18 (since 2012), through a ministernotmy approach (mean age 62.4, 21 female, 51%). In 32 patients (78%) the intervention was elective AVR. The homografts were obtained from the department's allograft bank and trimmed with the removal of both coronary sinuses, the noncoronary sinus was preserved in a triangular shape, 1 cm above the sinotubular junction. The transversal aortotomy was performed in a right angled “hockey cross” shape with the vertical segment centered on the noncoronary annulus. The homograft was implanted in the subcoronary fashion, the noncoronary Valsalva sinus was included in the aortic root of the patient by performing a concomitant root enlargement.
RESULTS:One patient had reoperation for bleeding and one patient died due to septic shock (2.3%). The mean ITU stay was 1.1 days, the mean ventilation time was 5.5 hours. In 2 patients the homograft was replaced at 14 and 15 years respectively, due to severe aortic regurgitation. In both cases, the leaflets were not calcified, but significantly shrank. The DNA test of the cells from the explanted leaflets were 100% similar to the patient' DNA, suggesting an in vivo decellularization of the homograft, followed by recellularization with host endothelial cells and later followed by a collagenolysis process.
CONCLUSIONS:The new technique combines the advantages of the cylinder implantation technique (no downsizing) with those of the classical subcoronary technique (less postoperative bleeding, no coronary manipulation). The ministernotomy approach offers further improvement in the quality of life.



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