New tools in minimal invasive aortic valve surgery: case report

Abstract: Minimal invasive aortic valve replacement (MI-AVR) is turning a routine surgical procedure, but still, many surgeons are reluctant because of perception of some technical difficulties like the annular suture placement and the legature. We present the surgical case of a MI-AVR by using novel suturing and knotting device that could facilitate surgery and diminish technical difficulties. This is the case of a 65-year-old female patient with a pathologic bicuspid aortic valve, with stenosis and prevalent regurgitation. The patient was symptomatic for dyspnea (NYHA Class II) and referred to surgery for AVR, and after obtaining informed consent, we performed MI-AVR through upper hemisternotomy (UHS) by using two new surgical devices, particularly designed for minimal invasive surgery. The first device is composed by two handpieces: one is known as RAM®, and it allows the passage of the suture, with the pledget in the ventricular side, through the native aortic valve anulus after the cusps have been removed and decalcification performed. Double “U” stitches are homogeneously and symmetrically placed. The second element, called SEW-EASY® is used to pass equally the double needle suture through the sewing ring of the valvular prosthesis. To conclude, in this case we have also utilized a second device, a knotting one, known as COR-KNOT®, giving rise to a quick and efficient suture ligature. Postoperative course was uneventful and the patient was on good conditions after 1 year of follow-up. The present case highlights the need and evolution of technology aimed to improve, simplify and increase safety in minimal invasive surgery.