Totally Endoscopic Aortic Valve Replacement With Triangulated Suturing: How to Do It

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Medical Device Technology

Background:

• Endoscopic aortic valve replacement (AVR) presents challenges due to limited space within the aorta.
• Precise instrument alignment is critical for successful suture placement during minimally invasive AVR.
• Existing techniques may struggle with achieving optimal angulation for suturing the aortic annulus.

Purpose of the Study:

• To describe a novel lateral suturing technique for endoscopic AVR.
• To demonstrate how instrument triangulation facilitates perpendicular suture placement.
• To enhance the feasibility of endoscopic AVR through improved instrument angulation.

Main Methods:

• A technique utilizing instrument triangulation for lateral suturing was developed.
• Procedures were performed via a 3 cm right anterolateral mini-thoracotomy using a 3D endoscope and femoro-femoral bypass.
• Key modifications include lateral positioning of the vent and transthoracic clamp, plus an additional lateral port for optimal instrument angulation.

Main Results:

• The described technique enables perpendicular stitches to the aortic annulus, mimicking open AVR procedures.
• Facilitates endoscopic suturing through a transverse aortotomy without automated devices.
• Allows implantation of both biological and mechanical aortic prostheses.

Conclusions:

• This lateral suturing technique effectively addresses instrument alignment challenges in endoscopic AVR.
• It simplifies the process of achieving perpendicular annular sutures, improving safety and applicability.
• The technique supports the use of various prosthetic valves in minimally invasive AVR.