Totsugawa Toshinori, Hiraoka Arudo, Tamura Kentaro, Yoshitaka Hidenori, Sakaguchi Taichi
From the Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Innovations (Phila). 2017 May/Jun;12(3):227-229. doi: 10.1097/IMI.0000000000000365.
Placing annular sutures at the right coronary cusp is difficult during minimally invasive aortic valve replacement. We propose the partial everting mattress method, whereby a prosthetic valve is implanted in a supra-annular position at the left coronary and noncoronary cusps, with pledgets on the left ventricular side, but in an intra-annular position at the right coronary cusp, with pledgets on the aortic side. Needles can be grasped in forehand pass at all three coronary cusps. Our method enables easy placement of annular stitches even in the small surgical field, without adversely influencing the hemodynamic performance of the prosthesis.
在微创主动脉瓣置换术中，在右冠状动脉瓣叶处放置环形缝线很困难。我们提出了部分外翻褥式缝合法，即人工瓣膜在左冠状动脉瓣叶和无冠状动脉瓣叶处以瓣环上位置植入，左心室侧放置垫片，但在右冠状动脉瓣叶处以瓣环内位置植入，主动脉侧放置垫片。在所有三个冠状动脉瓣叶处，持针器均可采用正手进针法。我们的方法即使在手术视野较小的情况下也能轻松放置环形缝线，且不会对人工瓣膜的血流动力学性能产生不利影响。
