Mini-Access Re-implantation Valve-Sparing Aortic Root Replacement in Acute DeBakey Type II Dissection

  • Cangsong Xiao
  • Yang Wu
  • Weihua Ye

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This video starts with an explanation of preoperative assessment, anesthetic management, and surgical preparation. Key steps of the procedure are precisely illustrated. Following is a demonstration of a mini access valve-sparing aortic root replacement through upper hemi-sternotomy using re-implantation technique in a Marfan syndrome patient with acute DeBakey type II dissection. The video aims to familiarize the practitioners with the whole process, thereby increasing confidence of surgical success.

Introduction

Acute aortic dissection as life threatening disease; DeBakey type II dissection is limited to an ascending aorta only. Aortic root replacement can be performed with replacement of the aortic valve using a prosthetic valve or by preserving the aortic valve in a valve-sparing root replacement. Coronary button anastomoses are the crucial part of operation strategy performance. This video presents a 27-year-old male patient suffering from sudden chest pain and diagnosed with acute dissection. Pre-operative TTE showed normal tricuspid leaflet and severe aortic valve regurgitation. The surgical plan includes upper hemi-sternotomy and cardiopulmonary bypass set-up, coronary button preparation and aortic root mobilization, sizing for tube graft and sub-annulus suture placement, commissure and sinus remnant re-attached to graft with left and right coronary button anastomosis. Post-operative recovery was uneventful and the patient was discharged home without any complication. Key to performance of success is to precisely secure the three commissures on the graft to optimize leaflet coaptation.

About the Authors

Cangsong Xiao

Professor Cangsong Xiao is the chief professor of Department of Cardiac Surgery in Chinese PLA General Hospital, Beijing, China.

 
Yang Wu

Professor Yang Wu is professor of Department of Cardiac Surgery in Chinese PLA General Hospital, Beijing, China.

 
Weihua Ye

Professor Weihua Ye is professor of Department of Cardiac Surgery in Chinese PLA General Hospital, Beijing, China.

 

About this video

Author(s)
Cangsong Xiao
Yang Wu
Weihua Ye
DOI
https://doi.org/10.1007/978-981-15-0154-8
Online ISBN
978-981-15-0154-8
Total duration
12 min
Publisher
Springer, Singapore
Copyright information
© Springer Nature Singapore Pte Ltd. 2019

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Video Transcript

[MUSIC PLAYING]

This video demonstrates Mini-access Valve-sparing Aortic Root Replacement through Upper Hemi-Sternotomy Using Re-implantation Technique in a Marfan Syndrome Patient with Acute DeBakey Type II Dissection.

This male patient was 27 years old. He suffered from sudden chest pain and was diagnosed as acute dissection.

Pre-operative TTE showed normal tricuspid deflate and a severe aortic valve regurgitation.

Pre-operative CTA showed aortic root aneurysm and DeBakey type II dissection, which was limited in sinus and proximal ascending aorta.

The sinus was perineal to the fourth intercostal space and it’s diameter was 52 millimeter.

Hemi-sternotomy was performed from manibrium to the fourth intercostal space. Sternum was transected.

Cardiopulmonary bypass was set up with distal aorta and right atrium cannulation and left ventricle was ventilated through right superior pulmonary vein.