Robotic Assisted Aortic Valve Replacement With Sutureless Aortic Valve For Aortic Valve Stenosis
Eiki Nagaoka1, Jill Gelinas1, Marco Vola2, Bob Kiaii1.
1London Health Science Centre, London, ON, Canada, 2University Hospital of Lyon, Lyon, France.
Objective: Robotic assisted mitral valve surgery has been validated and practically used. Meanwhile, robotic assisted aortic valve aortic valve surgery is still challenging and debatable in methodology.Methods: We retrospectively collected data and assessed feasibility on two patients, who underwent robotic assisted aortic valve replacement (AVR) in our institution. Results: Two patients with severe aortic valve stenosis, mean age of 75 (73 and 78), underwent robotic assisted AVR. Peripheral cannulation was achieved via the right femoral artery and vein . A 12 mm endoscopic port was inserted into right 2ndintercostal space. Two separate 7 mm ports were inserted in the 1stand 3rdintercostal space. The endoscopic ports were adapted to the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA) Using robotic assistance, the pericardium was opened and anchored to the skin from outside to expose the aorta. A small working incision was made in the same intercostal space as the camera port. After full heparinization, Cardiopulmonary bypass was initiated.A vent cannula was placed through the right superior pulmonary vein and a cardioplegia cannula in the ascending aorta. The aorta was separated from the pulmonary artery and then crossclamped with the transthoracic aortic cross clamp placed through the 2ndintercostal space in the anterior axillary line. After cardioplegic arrest, the aortic valve was exposed through a clam shell aortotomy. Valvectomy along with decalcification of the annulus of the aortic valve was performed. Three guiding sutures of 3-0 prolene were inserted in the nadirs of each aortic sinuses. The Perceval S valve (Liva Nova, Milan, Italy) was parachuted down using three guiding sutures and deployed. After confirming valve position, the aortotomy was closed. One patient developed atrial fibrillation postoperatively. Otherwise postoperative convalescence was uncomplicated. Conclusions: Robotic assistance as an addition to minimally invasive aortic valve procedure enabled excellent exposure of the aortic valve and improved manipulation and suturing of the aortic annulus and aorta. There needs to be improvement of instrumentation for valve deridement and removal of calcium from the annulus. In addition, The sutureless or rapid deployment valve technology further contributes to the feasibility and the efficacy of this procedure.
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