Sutureless aortic valve for minimally invasive multi valve composite surgery to "repair the heart" for patients

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Recently, Professor Li Yongxin’s team from the Cardiovascular Department of the First Affiliated Hospital of Xi’an Jiaotong University has demonstrated ingenuity by using a minimally invasive intercostal approach to successfully apply sutureless aortic valve in multi valve composite surgery, providing "heart repair" for an elderly patient with valve disease. It is reported that this is the first time in China to use suture-free aortic valves for multi valve composite surgery.




The patient is an elderly male who sought medical attention due to chest tightness and shortness of breath for several months. The diagnosis is severe aortic stenosis with regurgitation, severe mitral stenosis with regurgitation, and tricuspid regurgitation. Due to the patient’s advanced age, their heart function is severely damaged, with an EF value of only 40% (normal 50-70%). Three of the four "cardiac valves" are damaged, and the only treatment method is surgical multi valve composite surgery.


Multi valve composite surgery requires simultaneous replacement or repair of multiple valves, resulting in high technical difficulty and long surgical time. At the same time, patients with advanced age and severe aortic valve calcification make it difficult to remove calcified tissue, further increasing the time for extracorporeal circulation and aortic occlusion; If the calcification of the valve annulus is severe, after removing the calcified valve annulus, conventional valve replacement faces problems such as difficulty in suturing, easy tissue tearing, and high incidence of postoperative perivalve leakage atrioventricular block; Especially for patients with smaller valve rings, conventional valve replacement surgery can only implant valves with smaller valve rings, which may result in unsatisfactory hemodynamics and mismatched artificial valves after surgery.






Considering the complexity of the patient’s condition, Deputy Director Li Yongxin, Director Yan Yang, and Deputy Director Shi Tao fully evaluated and decided to use sutureless aortic valve replacement for the patient. At the same time, mitral valve biological valve replacement and tricuspid valve plasty were performed to simplify the surgical process as much as possible and shorten the surgical time. In addition, to minimize surgical trauma, the treatment of all three diseased valves requires a minimally invasive small incision of less than 5 cm.


After sufficient preoperative preparation, with the tacit cooperation of the anesthesia surgery department, cardiac ultrasound room, and extracorporeal circulation, Professor Li Yongxin’s team completed sutureless aortic valve implantation, bicuspid valve replacement, and tricuspid valve shaping in one go through a minimally invasive small incision of 4 cm in the third intercostal space next to the right sternum, removing calcified tissue and diseased valves. The implantation process of suture-free aortic valve avoids difficult operations such as thread hanging and knot fixation in traditional surgery, greatly shortens the time for surgery, cardiopulmonary bypass, and aortic occlusion, reduces blood damage, and reduces surgical risk. After surgery, the patient was transferred to an extracardiac ICU for monitoring and treatment.




Li Yongxin introduced that traditional open valve replacement surgery is highly traumatic and requires longer extracorporeal circulation and cardiac arrest time for artificial valve suturing and knotting. In sutureless bioprosthetic valve surgery, there is no need to sew and tie knots one by one, greatly reducing the time of cardiopulmonary bypass and cardiac arrest. In addition, compared to ordinary bioprosthetic valves, sutureless bioprosthetic valves have no suturing edges and a larger valve opening area, which can provide more sufficient valve opening area for patients with small valve rings, better hemodynamics, and better long-term prognosis. At the same time, it provides prerequisite conditions for interventional valve treatment in patients with artificial valve failure in the future.




In recent years, the Cardiovascular Surgery Department of the First Affiliated Hospital of Xi’an Jiaotong University has deeply cultivated and innovated in the field of minimally invasive cardiac technology, achieving remarkable results. In the future, the team will continue to strive for excellence and excellence, committed to promoting the innovation and development of cardiac surgery technology, providing more advanced and high-quality medical services for more cardiovascular disease patients, and assisting the vigorous development of China’s cardiovascular surgery industry.


This article is reprinted from "Dingxiangyuan"



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