Related Experiment Video
Updated: Sep 10, 2025
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Impact of Root Venting on Brain Injury in Minithoracotomy Aortic Valve Replacement: Prospective Evaluation With
Shuhei Nishijima1, Yoshitsugu Nakamura2, Yuka Higuma2
1Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan; Department of Cardiovascular Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
Background:
The predominant method for preventing cerebral infarction secondary to air embolism in cardiac surgery is the use of root vents to remove air. However, in the case of minimally invasive aortic valve replacement (MIAVR) surgery, the risk of air embolism is lower compared with other types of minimally invasive cardiac surgery, and some surgeons routinely forgo root venting. This study sought to quantify how much difference root venting makes in stroke and asymptomatic brain injury (ABI) incidence in MIAVR.
Methods:
The study enrolled patients undergoing elective MIAVR from January 2016 to March 2023 at 1 hospital. The patients were categorized into groups, with (R group) and without root venting (N group). All patients underwent brain magnetic resonance imaging, including diffusion-weighted imaging, 1 day preoperatively and 5 days post operatively.
Results:
The R and N groups consisted of 126 cases each. ABI incidence was significantly greater in the N group (46% vs 31%; P < .05). Only 1 patient in the entire cohort sustained a stroke (R group). The incidence of ABI was not significantly different among different sites of cannulation over all patients. However, the incidence of ABI was significantly lower in the R group than in the N group for patients whose cannulation site was the femoral artery.
Conclusions:
Deairing with a root vent resulted in fewer ABIs even in MIAVR. However, given that ABI is asymptomatic, the tradeoff between prevention of ABI and surgical simplicity should be considered.
Insights
Root venting during minimally invasive aortic valve replacement (MIAVR) reduces asymptomatic brain injury (ABI) risk. While stroke incidence was low, surgeons should weigh the benefit of de-airing against increased surgical simplicity.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Imaging
Background:
- Cerebral infarction prevention in cardiac surgery typically uses root vents to remove air.
- Minimally invasive aortic valve replacement (MIAVR) has a lower air embolism risk, leading some surgeons to omit root venting.
- The impact of root venting on stroke and asymptomatic brain injury (ABI) in MIAVR requires quantification.
Purpose of the Study:
- To evaluate the effect of root venting on stroke and ABI incidence in patients undergoing MIAVR.
- To compare outcomes between patients with and without root venting during MIAVR.
Main Methods:
- A cohort of 126 patients undergoing elective MIAVR with root venting (R group) and 126 without (N group) were analyzed.
- All patients had pre- and post-operative brain MRI with diffusion-weighted imaging.
- Patients were categorized based on the presence or absence of root venting.
Main Results:
- Asymptomatic brain injury (ABI) incidence was significantly higher in the no-root-venting (N) group (46%) compared to the root-venting (R) group (31%).
- Only one stroke occurred in the entire cohort, in the R group.
- ABI incidence was lower in the R group than the N group specifically for patients with femoral artery cannulation.
Conclusions:
- Root venting during MIAVR is associated with a reduced incidence of ABI.
- The decision to use root venting in MIAVR should consider the trade-off between preventing ABI and surgical simplicity.
- While root venting shows benefit in reducing ABI, its necessity in all MIAVR cases warrants further consideration.
Related Concept Videos
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
01:22Aneurysm IV: Nursing Management