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Results and Key Points Summary
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Mini Access Redo Valve-Sparing Aortic Root, Total Arch Replacement and Stented Graft Implantation after Type A Aortic Dissection Repair
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In this segment, the aortic valve-sparing procedure is demonstrated.
Keywords
- valve
- mattress
- commissure
- graft
- leaflet
- coaptation
Conflict of Interest
The authors declare that they have no conflict of interest.
About this video
- Author(s)
- Cangsong Xiao
- Yang Wu
- Weihua Ye
- First online
- 22 December 2019
- DOI
- https://doi.org/10.1007/978-981-15-0149-4_4
- Online ISBN
- 978-981-15-0149-4
- Publisher
- Springer, Singapore
- Copyright information
- © Springer Nature Singapore Pte Ltd 2019
Video Transcript
After aortic arch has been reconstructed, attention was paid to the aortic root surgery. The left coronary sinus was dissected into the level of annulus and was removed, leaving 5 millimeter remnant. The non-coronary sinus was also dissected to the level of annulus and it was removed.
The three commissures were mobilized. The annulus diameter was at 29 millimeter and a 32 millimeter graft was chosen. For each sinus, three mattressed sutures were placed in sub-annular position to anchor the graft. The sutures below left-non-coronary triangle were in the same plane.
Small notches were made to accommodate in the difference in height on the other two commissures. The sutures were evenly placed through in the graft.
The three commissure staying sutures were pulled out from the graft. The graft was parachuted into place and the sutures were tied.
The commissures were fixed on the graft because a mattressed sutures with felt pleget. To ensure optimal leaflet coaptation, the fixing point should be adjusted precisely. The graft and the commissure must be brought up so that the valve apparatus was elevated within the graft.
Notably, the coaptation of the valve leaflets should be in the plane that is higher than the valve annulus.
Optimal leaflet coaptation was confirmed by water flooding test.
Sinus remnant was sutured into the graft in baseball-stitch fashion.
Again, water was placed into the reconstructed aortic root to test the coaptation.
A small hole in the graft was made with cautery. The amount ofresidual tissue around the artery was minimized without compromising its origin. Then the left coronary button was re-attached to the graft.
And the right coronary button was re-attached to the graft.
Cardioplegia was infused to confirm hemostasis.
Coseal glue was spread. The branched graft was cut to proper length and then anastamosed to the tube graft.
After de-airing, aortic clamp was removed and the heart was re-perfused. After unclamping, attention must be paid to avoid the distention of the left ventricle.
The third limb of the branched graft was anastamosed to innominate artery.