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A Simple Device for Morphofunctional Evaluation During Aortic Valve-Sparing Surgery

https://doi.org/10.1016/j.athoracsur.2015.02.120Get rights and content

Valve-sparing operations for the treatment of aortic root disease with a structurally normal aortic valve are increasingly performed as they avoid prosthesis-related complications. Short- and long-term results are critically dependent on perfect intraoperative restoration of valve anatomy and function. Residual aortic regurgitation is the main cause of early failure, and it is the most common motive for reoperation. However, intraoperative morphofunctional valve assessment requires expertise, and only transesophageal echocardiography can provide reliable information. We describe a simple, economic, reproducible hydrostatic test to intraoperatively evaluate valve competency under direct visualization.

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Technique

The assembly of the tester requires a common 7F multilumen central venous catheter (Arrow International, Inc, Reading, PA), a 34- × 41-mm transparent polystyrene container (LP Italiana SpA, Milan, Italy), a high-temperature cautery (Bovie Medical Corporation, Clearwater, FL), and synthetic surgical glue (Glubran 2; Gem srl, Viareggio, Italy).

After creating a 2.4-mm (7F) hole on the bottom of the container with the cautery (Fig 1), the multilumen central venous catheter is inserted so that the

Comment

Although valve-sparing procedures have demonstrated excellent long-term results, the possible persistence of residual aortic regurgitation, often because of the lack of recognition of an intraoperative valve prolapse, may lead to premature failure and the need for reoperation. To date, only transesophageal ultrasound allows a reliable assessment of the success of a valve-sparing procedure [2]. However, the echocardiographic evaluation can only be performed at the end of the procedure, after

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