Aortic Valve Reconstruction with Three Same-Sized Autologous Pericardial Leaflets Guided by 3D Hologram Obtained from a Novel Workstation Visalius3D

Takeo Tedoriya, Kenichi Kamiy, Tadamasa Miyauchi, Masaomi Fukuzumi, Yuko Gatate

Ageo Central General Hospital, Cardiovascular Center, Ageo, Japan

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – D

Abstract

OBJECTIVE

Aortic valve reconstruction with three same-sized autologous pericardial leaflets has been performed for patients with narrow aortic roots or contraindication for valve-prostheses. Since this procedure requires precise information of the aortic root including configuration of Valsalva sinus, we assessed physiologic-anatomical condition of the aortic root by 3D hologram in order to accomplish this technique with a reproducible fashion.

METHODS

3D Hologram Imaging; Enrolled patients underwent enhanced ECG-triggered cardiac CT. Axial images with slice thickness of 0.625mm were obtained during mid-to-end diastole. Subtracted volume rendering data of the aortic root were converted to stereolithography (STL) file in Visalius3D. Preoperatively the aortic root was assessed in order to decide neo-commissure and offsetting of deviated nadir in cases of unbalanced aortic root.

Basic surgical technique was; 1) transverse ascending aortotomy, 2) same-sized three pieces of leaflets from autologous pericardium treated by 0.6 % glutaraldehyde for 6 minutes were tailored to original templates referred by STJ diameter, 3) the new commissures and nadirs were confirmed based on 3D hologram image, 4) in case the non-coronary nadir deviated toward the left ventricle, a crescent form Valsalva plication were required, 5) three leaflets were sutured on the cusp-suture-line by 4-0 continuous fashion in a ratio of 3:2 from the nadir to commissure height, 1:1 in commissure height, 6) commissure coaptation stitches were placed between each leaflet to prevent from minor leakage and coronary orifices obstruction, finally 7) STJ is fixed by a pericardial stripe as prevention of STJ dilatation.

RESULTS

Valsalva plication and commissure adjustment navigated by 3D hologram was accomplished as a preoperative plan. Postoperative mean pressure-gradient was 8.5 mmHg without any development of AR during follow-up.

CONCLUSIONS

Preoperative evaluation by 3D-Hologram had notably provides valuable information for adjustment of neo-commissure and nadir in our aortic valve reconstruction using three same-sized leaflets.