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International Society For Minimally Invasive Cardiothoracic Surgery

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3-d Hologram Evaluation Of Novel Technique For Aortic Valve Reconstruction With Three Same-sized Autologous Pericardial Leaflets
Takeo Tedoriya, Tadamasa Miyauchi, Yoko Gatate, Yoshimi Tamura, Masaomi Fukuzumi
Ageo Central General Hospital, Ageo, Saitama, Japan

Background: Aortic valve leaflet reconstruction using three same-sized autologous pericardium leaflets (ATLAS) has been performed for patients of the aortic valve disease with narrow aortic annuls or contra-indication of valve prosthesis. We evaluated outcomes of ATLAS with 3D-VR from CT data.Methods: From 2016, we have performed ATLAS in 28 patients (AS=12, AR=16), which was about 6% of our all aortic valve cases. Basic technique; 1) three same-sized leaflets were tailored to original templates referred by STJ diameter, 2) the new commissures and nadirs were confirmed based on VR image, 3) leaflets were sutured on the cusp-suture line, 4) commissure coaptation stitches were placed to prevent from minor leakage and coronary orifices obstruction. Enrolled patients underwent ECG-triggered cardiac CT. Axial images with slice thickness of 0.625mm were obtained during mid-to-end diastole. Subtracted volume rendering CT data were converted to the workstation to obtain 3D-VR image for assessment of pre- and post-operative valve structure. Since 3D hologram showed unbalanced aortic root like bicuspid in 9 patients, we performed additional annular adjustment procedures guided by 3D hologram simulation.Results: One patient died after 2 months due to sepsis of preoperative acute IE. In 27 patients, postoperative 3D hologram revealed the balance configuration of the aortic root and leaflet as we had designed preoperatively. One redo AVR was done due to perforation of one pericardial leaflet. In all of 26 patients, echocardiographic evaluation revealed no AR more than mild, and mean AVPG was 8.6mmHg after the surgery, 7.0mmHg in 1 year, 8.3mmHg in 3 years.Conclusions: ATLAS technique described herein can provide a simple and reproducible procedure that allows anatomical physiologic correction of the aortic valve. Notably, preoperative evaluation using 3D hologram image of the aortic root has provided valuable information for the adjustment of the neo-commissure and nadir in this procedure.


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