Successful valve-sparing in aortic root reconstruction under endoscopic guidance

Area of Science:

• Cardiovascular Surgery
• Medical Endoscopy
• Aortic Valve Disease

Background:

• Ascending aortic aneurysms often present with aortic insufficiency (AI).
• Valve-sparing aortic root reconstruction, including David reimplantation and Yacoub remodeling, are surgical options.
• Accurate intraoperative assessment of valve competence is crucial for successful valve-sparing procedures.

Purpose of the Study:

• To evaluate the utility of intraoperative endoscopic assessment in valve-sparing aortic root reconstruction.
• To determine if endoscopy can clarify procedural indications and assess the competence of the preserved aortic valve.
• To compare the outcomes of endoscopic guidance in different valve-sparing techniques.

Main Methods:

• Endoscopy was used to visualize the aortic valve in the proximal aortic root after cross-clamping.
• Valve coaptation was directly imaged before and after valve-sparing procedures in 17 patients.
• Aortic insufficiency (AI) severity was graded by aortography before and after surgery.

Main Results:

• Endoscopic guidance was employed in aortic root reconstruction (remodeling, reimplantation, or prosthetic replacement).
• AI grades were significantly reduced post-valve-sparing surgery.
• No early or late mortality was observed; remodeling showed superior long-term results compared to reimplantation, with no reoperations needed.

Conclusions:

• Intraoperative endoscopy is a valuable tool for assessing aortic valve competence during valve-sparing aortic root operations.
• Endoscopic evaluation successfully reduced postoperative AI and clarified the indications and limitations of these procedures.
• The remodeling technique, guided by endoscopy, demonstrated excellent long-term outcomes without requiring reoperation.