Aortic valve visualization and pressurization device: a novel device for intraoperative evaluation of aortic valve repair procedures

Abstract

OBJECTIVES Aortic valve repair procedures are technically challenging, and current intraoperative evaluation methods often fail to predict the final echocardiographic result. We have developed a novel intraoperative Aortic valve Visualization and Pressurization (AVP)device, enabling valve inspection under physiological conditions, and measuring aortic valve-insufficiency(AI) during cardioplegic arrest. METHODS The AVP device is attached to the (neo)aorta, after any type of aortic valve repair, while the heart is arrested. The root is pressurized(60-80mmHg) using a saline solution and an endoscope is introduced. The valve is inspected, and the amount of valvular leakage is measured. Postoperative “gold-standard” transesophageal echocardiogram measurements of AI is performed and compared against regurgitation volume measured. RESULTS In 24 patients undergoing valve-sparing root replacement, the AVP device was used. In 22 patients postoperative echocardiographic AI was ≤ grade 1. The median leakage was 90 ml/min, IQR 60–120 ml/min. In three patients additional adjustments after visual inspection was performed. In two patients, with complex anatomy, the valve was replaced. In one, after evaluation with the device, there was undesirable result visually and residual AI of 330 ml/min, in another, 260 ml/min residual AI was measured and valve restriction on visual inspection. CONCLUSION The novel Aortic valve Visualization and Pressurization device enables intraoperative evaluation of the valve under physiological conditions, while still on arrested heart, and allows for targeted adjustments. The AVP device can be an important aid for intraoperative evaluation of the aortic valve, during valve repair and valve-sparing procedures, thereby making the operative result more predictable and the operation more efficient.

Effectiveness of intraoperative endoscopic evaluation in aortic valve repair with valve-sparing aortic root replacement: a comparison of short- and mid-term results

“…Arbakhani et al has also elaborated on the value of this approach for aortic valve plasty. The postoperative residual AI grade was found to correlate with the leakage measured by their intraoperative device and was validated for use during AVP procedures [ 14 ]. However, previous studies described only endoscopic evaluations for final confirmation after second-row suturing [ 3 , 4 , 15 ].…”