A Novel Device For Standardization Of Valve-sparing Aortic Root Reimplantation
Ahmet Elibol
Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
Background: Among valve-sparing aortic root replacement techniques developed for the treatment of aortic root aneurysms and aortic insufficiency, the reimplantation technique (the David procedure) has proved to provide excellent outcomes in experienced hands. However, it involves challenges in technical standardization, particularly for graft sizing, which is still far from standardization.Rationale: A novel device was developed to facilitate and provide all the measurements in high precision and accuracy required for the David procedure. Innovation: The device allows easy, rapid and accurate acquisition of the patient’s data and appropriate configuration of the aortic valve, independent of the surgeon's subjective evaluations. The device provides the major parameters including the subannular suture line and effective height without the need for visual estimation. It also allows simulation of the aortic coaptation to check optimal valve geometry and competence through mounting of the graft on the device. The device was successfully tested on a Devotini aortic root simulator and on a bovine heart ex vivo. Conclusion: The device has three main advantages: (i) it provides the appropriate graft size based on an objective determination of the effective height. (ii) all measurements required for the David procedure can be obtained on this device, free from individual interpretations. (iii) The device provides excellent guidance for placing the graft in position. The device may contribute to the technical standardization of the reimplantation technique. 
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