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Published on: March 26, 2018
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Reverse-U Aortotomy (Kırali Incision) for Aortic Valvular Interventions.
Mustafa Mert Ozgur1, Hakan Hancer1, Fatih Yigit1
1Department of Cardiovascular Surgery, Kosuyolu High Specialization Education and Research Hospital, Istanbul, Turkey.
The Thoracic and Cardiovascular Surgeon
|January 31, 2024
Summary
A novel aortic incision technique, the Kırali incision, offers safe and effective exposure for aortic valve interventions, including complex cases. This method provides excellent aortic root visualization and protects grafts, proving a viable alternative to traditional approaches.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Innovation
Background:
- Ascending aorta surgical incisional approaches are critical for aortic valve and subvalvular interventions.
- Traditional aortotomy incisions (transverse, oblique) can limit aortic root exposure, especially in patients with small aortic annuli or undergoing redo coronary artery bypass grafting with proximal graft interference.
Purpose of the Study:
- To evaluate the safety and efficacy of the Kırali incision, a novel aortotomy technique, for aortic valve and subvalvular interventions.
- To assess the Kırali incision's ability to provide adequate aortic root exposure and protect existing grafts.
Main Methods:
- The Kırali incision, an inverted 'U' shape, was utilized in 91 patients (13 reoperations) undergoing aortic interventions.
- The incision extends from above the right coronary ostium towards the noncoronary annulus and left-right commissure, resembling a tongue.
Main Results:
- Aortic valve replacement (mechanical/bioprosthetic) was performed in 84 patients; 29 had concomitant procedures (CABG, LVAD).
- No perioperative complications related to the aortotomy incision (bleeding, rupture, dehiscence, laceration) were observed.
- No procedure-related complications occurred during a 5-year follow-up period.
Conclusions:
- The Kırali incision is a safe and effective aortotomy technique for diverse aortic valve interventions.
- It ensures good aortic root exposure, protects grafts, and facilitates aortic root enlargement or aortoplasty.
- This technique presents a promising alternative to conventional aortotomy methods.
