RU2554222C2 - Device for intraoperative measurement of aortic annulus diameter, formation of proximal portion of vascular implant for aortic root repair - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to cardiosurgery and is applicable for the surgical repair of the aortic valve and ascending aorta. A device comprises a screw-on handle, which bears a replaceable working portion configured in different diameters. The working portion is cylinder-shaped with a truncated cone, which comprises streamline circular grooves. The grooves are provided to prevent the vascular implant displacement if narrowed when underrun. A base of the working portion has a circular support configured to hold the vascular implant on the device.

EFFECT: invention provides the intraoperative measurement of a true size of the aortic annulus and formation of a reference size of the proximal portion of the vascular implant.

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Description

The invention relates to medicine, namely to cardiac surgery, and can be used to perform reconstructive operations on the aortic valve, the ascending aorta by intraoperative measurement of the diameter of the fibrous ring of the aortic valve, the formation of a vascular prosthesis for reconstruction of the aortic root.

Surgical treatment of patients with dissection of the ascending aorta with concomitant aortic valve insufficiency is still an urgent problem. Interest in valve-saving operations is growing every year. These operations are accompanied by a relatively low risk and give good long-term results [1]. Reconstructive heart valve surgery has advantages over replacement in terms of operational mortality, functional outcomes and survival. At the same time, Bentall De Bono surgery is the gold standard for patients with ascending aortic aneurysm and its arch. However, this type of operation involves replacing your own aortic valve with a mechanical prosthesis, as well as replacing the aortic root with a vascular prosthesis, which entails the need for lifelong administration of anticoagulants and can lead to the development of bleeding and cause thromboembolism. This is especially true for young patients. Thus, reconstruction of the aortic root while preserving its own aortic valve is considered as a selection procedure in this category of patients, and is also associated with low operational mortality and complications, better hemodynamic characteristics, and better preservation of left ventricular function, thereby improving long-term survival [2].

A device for measuring the fibrous ring of the aortic valve "MEDING" [3]. The device has replaceable plastic rings with a diameter of 19, 21, 23, 25, 27, 29 mm, which, before performing prosthetics of the aortic valve, measure the fibrous ring of the aortic valve and use the corresponding replaceable ring.

The disadvantages of this model are the lack of a streamlined shape of the device that prevents damage to the aortic valve cusps, the lack of emphasis on the working part, which does not allow less traumatic and more accurate measurement of the fibrous ring of the aortic valve, stitching and giving the necessary diameter of the proximal part of the vascular prosthesis to perform root reconstruction and ascending aorta.

Geghar bugs are known [4], used to expand the trunk of the pulmonary artery, which are a metal set of dilators with a diameter of 1 to 26 mm, with a pitch of 0.5 mm.

The disadvantages of this model are the inability to measure the fibrous ring of the aortic valve due to the asymmetric shape, the inability to form the proximal part of the vascular prosthesis. The trauma of the measurement, the asymmetric design of the bougie makes them practically unsuitable in reconstructive surgery of the aortic root.

Tasks: to provide intraoperative measurement of the true size of the fibrous ring of the aortic valve, to form the proper diameter of the proximal part of the vascular prosthesis.

For a better understanding, the device is schematically shown in general side view in FIG. 1, where 1 is a screw handle, 2 is a circular stop, 3 is a circular groove, 4 is a cylinder with a truncated cone, 5 is a replaceable working part.

The essence of the invention is the presence of a screw handle on which a working part is fixed, made removable with different diameters, having the shape of a cylinder with a truncated cone, on which streamlined circular grooves are located, made with the ability to prevent the displacement of the vascular prosthesis during its narrowing due to flashing, and the base the working part is equipped with a circular stop, made with the possibility of fixing the vascular prosthesis on the device.

The technical result consists in accurate intraoperative measurement of the diameter of the fibrous ring of the aortic valve, in the ability to form (narrow) the proximal part of the vascular prosthesis to the proper diameter to perform reconstruction of the aortic root. Eliminated the need to use other expensive vascular prostheses, other surgical instruments, reduces labor costs. The claimed technical result is achieved due to the fact that the device allows intraoperatively to measure the size of the fibrous ring of the aortic valve, to form the proximal part of the vascular prosthesis of the proper diameter. The replaceable working part of the device is equipped with streamlined circular grooves for fixing a two-row suture, which allows to narrow the proximal part of the vascular prosthesis to the proper diameter.

The device is used as follows: they access the aortic valve, isolate the aortic root, attach the screw handle 1 to the removable working part, which is presented in the form of a cylinder with a truncated cone 4 of the required size. Next, the removable working part of the device is immersed in the cavity of the left ventricle through the hole of the fibrous ring of the aortic valve, the size of which corresponds to one of the dimensions of the working part 5 of the device. The device is immersed in the proximal part of the vascular prosthesis of the required diameter for each particular patient, while the vascular prosthesis abuts against the circular stop 2, thereby allowing the prosthesis to be fixed on the device. Next, the proximal part of the vascular prosthesis is stitched with two polypropylene sutures in the horizontal direction and the vascular prosthesis is narrowed to the proper diameter. Streamlined circular grooves 3 prevent the displacement of the vascular prosthesis on the device when the latter is narrowed, which increases the convenience of the surgeon and allows you to get a border of the proximal end of the vascular prosthesis with a width that exactly matches the size of the fibrous ring of the patient’s aortic valve. In this way, a newly created aortic root is obtained in which aortic valve cusps are reimplanted.

The device was tested on 33 patients (27 men, 6 women, average age 49 ± 17 years) who underwent aortic valve reimplantation. 15 patients had aortic dissection: 7 (3 acute) patients had De Bakey, type I, 8 (4 acute) patients had De Bakey, type II. 20 patients had regurgitation of 3 tbsp. Aortic valve reimplantation was used according to the method of T. David. Additional surgical procedures: 9 patients underwent an intervention on the aortic arch according to the “half-arc” type, 8 patients underwent aortic valve plastic surgery, 4 - coronary artery surgery, 1 - mitral valve plastic surgery. Results. Hospital mortality 6% (2/33). 3 patients underwent reoperation due to regurgitation on the aortic valve. In other patients, the function of the aortic valve in the distant period remains satisfactory.

Example. Patient K., 62 years old, was admitted with complaints of shortness of breath with minimal physical exertion. From the anamnesis it is sick about 6 years. On echocardiography, an increase in the size of the left ventricle, left atrium, aneurysm of the aortic root is noted. The size of the aorta at the level of the Valsalva sinuses is 50 mm, severe aortic valve insufficiency, the size of the fibrous ring of the aortic valve is 23 mm. Intraoperatively: after excising the sinuses of the Valsalva, ascending aorta, the screw handle was fixed to the removable working part of the device, presented in the form of a cylinder with a truncated cone, which was inserted into the cavity of the left ventricle through the fibrous ring of the aortic valve to determine the exact size of the fibrous ring of the aortic valve. It was revealed that it is equal to 23 mm. A vascular prosthesis with a diameter of 32 mm was placed on a removable working part of the device, presented in the form of a cylinder with a truncated cone with a diameter of 23 mm, with streamlined circular grooves, while the vascular prosthesis rested on a circular stop. With two polypropylene filaments at a distance of 2-3 mm from each other in the horizontal direction, the vascular prosthesis is stitched and narrowed to a diameter of 23 mm, after which the own aortic valve was reimplanted into the vascular prosthesis. Thus, a new aortic root of the appropriate size was created for this patient. After surgery on echocardiography, the aortic valve function is satisfactory, there is no regurgitation, the size of the left ventricle has decreased. The patient was discharged in satisfactory condition. The long-term result - the patient was examined 1 year after the operation, has no complaints, his condition is satisfactory.

Information sources

1. Barbuhatti K.O., Boldyrev S.Yu., Belash S.A. et al. Aortic root reconstruction in patients with aneurysm and dissection of the ascending aorta and concomitant aortic valve insufficiency. Cardiology and cardiovascular surgery. - 2012 - No. 1. - S. 52-55.

2. David T.E., Feindel C.M., Webb G..D. et ail. Aortic Valve Preservation in Patients With Aortic Root Aneurysm: Results of the Reimplantation Technique Ann Thorac Surg 2007; 83: 732-735.

3. Internet search databases: http://www.medeng.ru; http://www.martin-med.com.

4. Barbuhatti K.O., Boldyrev S.Yu., Belash S.A. et al. Reconstruction of the aortic root in patients with aneurysm and dissection of the ascending aorta. Bulletin NTSSSH them. A.N. Bakuleva RAMS. - 2012 - Volume 13. No. 6. - S. 24.

Claims (1)

A device for intraoperative measurement of the diameter of the fibrous ring of the aortic valve and the formation of the proximal part of the vascular prosthesis for reconstruction of the aortic root, including a screw handle on which a working part is fixed, made replaceable with different diameters, having the shape of a cylinder with a truncated cone on which streamlined circular grooves are located made with the ability to prevent the displacement of the vascular prosthesis during its narrowing due to flashing, and the base of the working h Asti is equipped with a circular stop, made with the possibility of fixing the vascular prosthesis on the device.