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Results and Key Points Summary
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Re-implantation Valve-Sparing Aortic Root, Total Arch Replacement, Stented Graft Implantation and CABG
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In this segment, commissure and sinus remnant re-attachment to graft are shown.
Keywords
- reimplantation
- aortic
- valve
- sparing
- procedure
- graft
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/10.1007/978-981-15-0159-3_4
- Online ISBN
- 978-981-15-0159-3
- Publisher
- Springer, Singapore
- Copyright information
- © Springer Nature Singapore Pte Ltd 2019
Video Transcript
After arch reconstruction, aortic root surgery was again proceeded. The right coronary button was prepared. Three commisure staying sutures were placed. The left coronary button was prepared. The left and lung coronary sinus was dissected to the level below nadirof annulus. For each sinus, three mattress sutures were placed in subannular position to anchor the graft. The sutures below left non coronary triangle was in the same plane, but from right left and the right lung coronary triangle sutures should be placed corresponding to the crescent shape of annulus.
A 28 mm tubular grafting was chosen according to the size of aortic root. Small notches were made to accommodate the difference in height on the other two commissures. The sutures were evenly placed through the graft. The three commissure staying sutures were pulled out from the graph.
The graft was parachuted into place, and the sutures were tied. To find the appropriate fixing point of commissure to the graft for optimal leaflet coaptation, graft and the commissure must be brought up so that the valve apparatus was elevated within the graft. Then the commissures were fixed on the graft using mattress sutures. Notably, the coaptation of valve leaflets should be in the plane that is higher than the annulus.
After optimal leaflet coaptation was confirmed by a water flooding test, sutures were tied. 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. A circular bovine pericardium was used to reinforce the coronary button, which was involved by dissection. Then the left coronary button was reattached to the graft, and the right coronary button was reattached to the graft in the same fashion. The branched graft was cut to proper length, and anastomosed to the tube graft.
The proximal right coronary artery was bypassed with great saphenous vein. 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.