Study On Surgical Techniques About Paravalvular Leakage Repairing After Aortic Valve Replacement

ObjectivesWe aim to explore when paravalvular leakage happened after aortic valve replacement surgery,besides removing the original artificial valve routinely,whether there is other alternative surgical method.And we hope to find the optimal scheme by some research.MethodsWe designed several relevant controlled experiments using the pig hearts in vitro,and created a model to simulate the phenomenon of PVL after valve replacement surgery in clinical.Under a certain pressure,we measured the water volume of leakage before and after sealing,as well as the volume after the closure through pericardium patch folding in different way and layers,respectively.We observed the surgical procedure effect of PVL repairing and the influence on the open of coronary artery and work of valve leaflet.ResultsWe performed an aortic valve replacement(AVR)surgery in vitro pig heart,and measured the average leakage volume from left ventricle(V0)was 197 ml,meanwhile we keep the pressure of aortic artery root the same as normal diastolic blood pressure.Then removed one suture in non-coronary sinus of aortic valve,just passed through by the roof of right-angle clamp(24cm Separate and ligation forceps).Because it's incapable to measure the diameter of leakage directly,we reckoned it was about 4mm according to the roof of right-angle clamp.We measured the average water volume of leakage(V0')was 474 ml.Folding the same wide pericardium patch(4mm)in simple way,when folding in 5 layers,the water volume in one minute was minimum from left ventricle(LV).We still kept same wide pericardium patch folding 5 layers and maintained other variables,but respectively folded the patch in simple way(like a cordwood system),positive and negative pyramid way,dumbbell-shaped and spindle way to seal this time.And we found the way of simple folding made the water leakage volume from LV in one minute minimum,that is,the effect of surgical procedure is best at that time.ConclusionsThe method of folding pericardium patch to closure(folding-type sealing method)can be an alternative surgical procedure when paravalvular leakage happened after aortic valve replacement surgery under certain conditions.Besides,according to the different size of PVL,our research concluded a series of surgical procedure techniques,including the method of sealing above annulus,folding-type sealing method,annulus up & down complex sealing method,the method of pericardium patch using as valve.Surgeons can choose an optimal surgical PVL repairing procedure to replace the routine way of removing original prosthesis,according to specific situation in a surgery.