Endoscopy in aortic valve repair: does it worth it?

Fanar Mourad, Sharaf-Eldin Shehada, Jaroslav Benedik, Juri Lubarski, Daniel Wendt, Mohamed El Gabry, Heinz Jakob, Konstantinos Tsagakis


Background: Aortic valve repair (AVR) is a technically challenging procedure. Usually, the repaired valve is checked after weaning from cardiopulmonary bypass (CPB). We aimed to evaluate intraoperative and clinical outcomes of AVR patients in whom intraoperative aortic root endoscopy was applied.
Methods: The present study was a retrospective single-center study. An autoclavable video-scope was used to evaluate aortic valve. During endoscopy, crystalloid cardioplegia was administered to pressurize the aortic root. Primary endpoints were: need for Re-CPB after weaning from bypass and early postoperative aortic valve regurgitation. Secondary endpoints included: 30-day mortality and freedom from aortic regurgitation/reoperation during follow-up.
Results: A total of 66 consecutive patients who underwent AVR (05/2014–03/2017) were evaluated. Patients mean age was 53.5±14.5 years and 74.2% were male. Seventy-three percent of the patients were in New York Heart Association (NYHA) functional class III/IV. The main underlying aortic valve pathology was aortic valve regurgitation in 83.3%, 9.1% aortic stenosis and combination of both in 7.6%. A tricuspid or bicuspid aortic valve was observed in 48.5% and 43.9%, respectively, whereas 7.6% showed a functional unicuspid aortic valve. Intraoperative results revealed endoscopy as a helpful tool, where second time cross-clamp was avoided in most (58, 87.9%) of patients. Thirty-day mortality was 3.0%. During follow-up (28±10 months), 2 patients required re-operation due to recurrent aortic valve regurgitation.
Conclusions: The present analysis showed, that intraoperative aortic valve endoscopy is a helpful tool to evaluate AVR before weaning from bypass. This easy-to-use tool gives real-time information about the intraoperative result and might provide additional guidance to achieve optimal results after AVR.