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Leaflet Reconstructive Techniques for Aortic Valve Repair

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Presentation on theme: "Leaflet Reconstructive Techniques for Aortic Valve Repair"— Presentation transcript:

1 Leaflet Reconstructive Techniques for Aortic Valve Repair
Domenico Mazzitelli, MD, Christof Stamm, MD, J. Scott Rankin, MD, Steffen Pfeiffer, MD, Theodor Fischlein, MD, Jan Pirk, MD, Yeong- Hoon Choi, MD, Christian Detter, MD, Johannes Kroll, MD, Friedhelm Beyersdorf, MD, Malakh Shrestha, MD, Christian Schreiber, MD, Rüdiger Lange, MD  The Annals of Thoracic Surgery  Volume 98, Issue 6, Pages (December 2014) DOI: /j.athoracsur Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 (A) Testing left coronary leaflet effective height with the Schäfers caliper and appearance of right cusp (RC) prolapse with leaflet fracture line. (B) Appearance of right coronary leaflet after symmetrical perinodular plication and correction of prolapse. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Release of a retracted nodulus Arantius by use of CUSA unfolding. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Sequential steps in double patching of a leaflet hole with autologous pericardium. (A) Hole in noncoronary cusp. (B) Double autologous pericardial patch is sutured over the hole with fine mattress sutures. (C) Hole closed after sutures are tied. (D) No residual leak by transoesophageal echocardiography. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Reconstructed chronically ruptured commissures with the use of double pericardial strips of autologous pericardium placed from the noduli Arantii to the aortic wall. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Sequential steps in complete pericardial leaflet replacement. (A) After left coronary leaflet proved irreparable, the leaflet and annular sutures were excised. (B) Three new “looping” sutures are passed around the ring, up through the annulus, and through the autologous pericardial leaflet. (C) Looping sutures are tied, and new post sutures are placed, incorporating the pericardial leaflet. (D) Post sutures are tied, commissural alignment sutures are passed through the base of both leaflets, and the new leaflet is plicated to fit the others [25]. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 Appearance of autologous pericardial leaflet replacing a defective noncoronary cusp. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 7 Preventable iatrogenic defects. (A) Suture untying producing partial ring dehiscence. (B) Tearing of a repaired leaflet by a long annular suture tail. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

9 Fig 8 Method to prevent suture untying and leaflet injury from long suture tails. (A) Tying eight tight knots. (B) Passing one needle through the lateral pledget and tying six more knots. (C) Cutting the suture tails short. (D) All suture tails are directed down and away from the leaflets. (In each Panel, the arrow refers to the action listed.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

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