A Novel Device for Intraoperative Direct Visualization of a Pressurized Root in Aortic Valve Repair.

PURPOSE:One major challenge in generating reproducible aortic valve (AV) repair results is the inability to assess AV morphology under physiologic pressure. A transparent intraoperative AV visualization device was designed and manufactured. DESCRIPTION:This device comprises an open proximal end, a cantilevered edge to allow attachment of the device to the aorta or graft, a distal viewing surface, and 2 side ports for fluid delivery and air removal. EVALUATION:The performance of the device was evaluated ex vivo using normal porcine AV in situ (n = 3), porcine AV after valve-sparing aortic root replacement (VSARR) (n = 3), porcine pulmonary valve in the Ross procedure (n = 3), and in 3 patients who underwent VSARR. AV morphology was clearly visualized using the device in all experiments. In human subjects, the use of this device successfully showed cusp prolapse after the initial VSARR and effectively guided additional cusp repair. CONCLUSIONS:This device successfully allows for direct visual assessment of the AV apparatus under physiologic pressure. The use of this device can potentially increase the adoptability of AV repair in clinical practice.