A novel device for technical standardization of valve-sparing aortic root reimplantation

Among valve-sparing aortic root replacement techniquesdeveloped for the treatment of aortic root aneurysms and aorticinsufficiency, the reimplantation technique (the David procedure)has proved to provide excellent outcomes in experiencedhands. However, it involves certain challenges in technicalstandardization, particularly for graft sizing, which is still farfrom standardization. A novel device was developed to facilitateand provide all the measurements in high precision and accuracyrequired for the David procedure. The device allows easy, rapid,and accurate acquisition of the patient’s data and appropriateconfiguration of the aortic valve, irrespective of the surgeon'ssubjective evaluations. This all-in-one device provides all themajor parameters including graft size, effective height, graftpreparation, and simulation of the aortic coaptation. The devicewas successfully tested on a Devotini aortic root simulator andon a bovine heart ex vivo. The device proposed herein to be usedfor reimplantation has one explicit advantage: all valve geometryto be reconstructed and repaired can be simulated on the devicewith all its elements, in particular, the commissures and thecusps. Thus, all that is necessary can be clearly visualizedin a manner whatever the configuration the surgeon prefers,particularly the creation of the effective height.

Kapak koruyucu aort kök reimplantasyonunun teknik standardizasyonu için yeni bir cihaz

Aort kök anevrizmaları ve aort yetersizliği tedavisi için geliştirilen kapak koruyucu aort kök replasman teknikleri arasında, reimplantasyon tekniğinin (David işlemi) deneyimli ellerde mükemmel sonuçlar ortaya çıkarabildiği kanıtlanmıştır. Ancak, başta standarttan uzak greft büyüklüğü olmak üzere, teknik standardizasyon açısından birtakım kısıtlılıkları mevcuttur. David işlemi için gerekli kesin ve doğru ölçümleri kolaylaştırmak ve sağlamak amacıyla yeni bir cihaz geliştirildi. Bu cihaz sayesinde cerrahın öznel değerlendirmelerinden bağımsız olarak hastaların verileri kolay, hızlı ve doğru bir şekilde alınabilmekte ve aort kapağı uygun bir şekilde konfigüre edilebilmektedir. Hepsi bir arada olan bu cihazda greft büyüklüğü, etkili yükseklik, greft hazırlığı ve aort koaptasyon simülasyonu dahil olmak üzere başlıca parametreler mevcuttur. Cihaz Devotini aort kök simülatörü ve ex vivo sığır kalbi üzerinde başarılı bir şekilde test edilmiştir. Reimplantasyon için kullanılmak üzere bu makalede anlatılan cihazın belirgin bir avantajı da vardır: yapılandırılacak ve onarılacak kapak geometrisi, komissür ve kusplar başta olmak üzere tüm komponentleri ile bu cihazda simüle edilebilir. Bu nedenle, gerekli olan her şey, bilhassa etkili yüksekliğin yaratılması, cerrahın tercih ettiği konfigürasyon ne olursa olsun, açıkça görüntülenebilir.

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