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Surgical AVR for Severe Aortic Stenosis (2014 Asai)

My detailed technique of surgical AVR for AS is demonstrated in this video. Incision of the proximal aorta is located at 5-10 mm above the right coronary arterial orifice ( Low Aortotomy ). Calcified cusps and annular lesion are completely removed in enblock fashion. Especially calcified lesion close to annulus and sinus of valsalva is "de-laminated" from normal remaining tissue. Remnant of cusp is meticulously shaved. Implantation technique is 12 pairs of non-everting mattress suture of 2-0 Nesporen. A maximally large size of bioprosthesis is easily implanted in this case, (27 mm Magna Ease, Edwards Life Science). Three "Nadirs", lowest points of annuli are securely approximated by a tonsil forceps, so as to lower down the prosthesis appropriately. Sutures are tied securely. No parevalvular space or leak would occur in this technique. (Japanese transcript in the video.)