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Robotic AVR Simplified, Longitudinal Aortotomy
Zeynep Sila Ozcan1, Gokhan Arslanhan1, Murat Bastopcu2, Anil Karaagac2, Ibrahim Gokce3, Muharrem Kocyigit4, Aleks Degirmencioglu5, Sahin Senay1, Cem Alhan1.
1Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey, 2Acibadem Altunizade Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey, 3Acibadem University School of Medicine, Istanbul, Turkey, 4Acibadem University School of Medicine, Department of Anesthesiology, Istanbul, Turkey, 5Halic University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
The patient was a 51 year old male who presented with severe aortic and mitral valve regurgitation. He underwent robotic mitral valve and aortic valve replacement. Our usual robotic setup for valve operations was used. A mini-thoracotomy was performed through the 3rd ICS. After cardioplegia delivery and cardiac arrest, left atriotomy was performed and the mitral valve was replaced. Following this step, a longitudinal aortotomy was performed and the aortic valve was replaced. Whilst working with the robotic arms on the aortic valve inside the aortotomy, excessive stress is placed on the aortic wall by the robotic arms which may cause the horizontal aortotomy to extend in an uncontrolled way. Performing a longitudinal aortotomy may prevent this, reducing the stress placed on the aortic wall by the robotic arms. Any potential bleeding or oozing from the aortotomy site after the aortotomy is closed would be on the anterior wall of the aorta after a longitudinal aortotomy, thus making it easier to localize and interfere. Thus, a safer approach can be employed to achieve exposure to the aortic valve during robotic operations.
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