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A New Automated Minimally Invasive Aortic Valve Replacement Suturing Technique
Amber Melvin, MD1, Joshua Wong, MD1, Devang Joshi, MD1, Heather Gorea, BSME2, Angelo Martellaro2, Jude Sauer, MD2, Peter Knight, MD1.
1University of Rochester, Rochester, NY, USA, 2LSI SOLUTIONS, Victor, NY, USA.

OBJECTIVE: Despite the many potential therapeutic advantages of Minimally Invasive Cardiac Surgery (MICS) aortic valve replacement (AVR), this promising procedure’s widespread adoption amongst cardiac surgeons has not yet occurred due to its complexity and technical challenges. Exposure of the valve and adequate placement of sutures in the annulus present a difficult barrier to ergonomic and reliable remote AVR surgery. This study evaluated a novel automated approach to minimally invasive AVR annular and prosthetic suturing through a right anterior mini-thoracotomy access site.
METHODS: To develop and evaluate the functionality of this technique, 9 minimally invasive AVR operations were sequentially performed in cadavers using two new automated technologies: an aortic annulus suturing device and a cardiac prosthetic valve sewing cuff suturing device. A right anterior mini-thoracotomy was made in the 2nd intercostal space to access the aortic valve. Following aortotomy, the native aortic valve was removed. A commercially available AVR bio-prosthetic tissue valve was then implanted employing both devices. In addition to evaluating the devices’ functional mechanisms, factors such as operative angles, depth of bite in the annulus, apposition of the valve to the annulus and surgeon ergonomics were investigated.
RESULTS: All 9 aortic valve prostheses were successfully implanted in study cadavers with satisfactory device function and prosthetic-annulus apposition.
CONCLUSIONS: This minimally invasive aortic valve replacement technique using automated aortic annulus and cardiac prosthesis suturing devices is a feasible way to perform this beneficial, but challenging surgery. The successful results of this research encourage further exploration of this technology and technique towards its future clinical use in minimally invasive AVR surgery.

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