A new instrument and technic for artificial heart valve replacement

A New Instrument Artificial

Heart

and Technic Valve

for

Replacement

J. L. CASTILLO-OLIVARES, M.D., Shefield, England

From the Department of Car&o-Thoracic Surgery, City General Hospital and Royal Infirmary, Shefield, Eng-

DESCRIPTION OF THE INSTRUMENT The instrument, which is made of stainless steel (Fig. l), has two parallel oval rings, each measuring 25 cm. by 15 cm. in diameter, which are placed parallel to one another. The upper ring is positioned into the lower one by four legs, at a distance of 10 cm. In each quadrant of the upper ring is a mobile bar holding a spring. On the north side of the upper ring a curve bar can be applied which will hold the prosthesis over the operative field. There are two types of holders, one for the Starr-Edwards and the other for the Alvarez or Hammersmith valves. (Fig. 1.) The distance between the valve holder and the lower ring is 16 cm. On the two posterior legs of the instrument are two small mobile vises for supporting the coronary perfusion or suction cannulas.

land.

HEN surgery such as heart valve replaceis undertaken, it is easy to understand the tremendous difficulties and embarrassment produced by the large amount of tubes required for the procedure, such as atria1 cannulas, carbon dioxide line, coronary perfusion cannulas, left ventricular decompressor, femoral line, and suction cannulas. If to all this is added between twenty and twenty-five stitches needed to fix the artificial prosthesis to the valve ring, the advantages of employing a technic which will maintain a tidy operative field become apparent. It is the aim of this paper to describe our own technic using a new instrument made for this purpose.

W ment

FIG. 1. A, instrument unmounted. Vol.

114,December

1967

TECHNIC After the chest is open, the lower ring is used

mounted with two types of valve holder. B, instrument

975

Castillo-Olivares

Fig. 2. The pericardium is stitched to the lower ring and the heart Fig. 3. The upper ring is plugged top of the upper ring. Fig. 4. The instrument

with

into the lower rillg. A holder

tile Alvarez

Fig. 5. All the stitches have been passed controlled c ver the springs on the upper

valve through ring.

is exposed.

for an Alvarez

or Hammer-smith

valve

can be seen on

in poGtion a mitral

for fixation of the pericardium to achieve exposure of the heart. (Fig. 2.) When the patient is on bypass and the decision to replace the valve has been made, the upper ring is plugged into the lower one (Fig. 3 and 4), the chosen prosthesis is fixed in the holder, and the holder is screwed into the upper ring. The surgeon passes the double stitches through the ring of the valve and the first assistant passes them through the mesh around the prosthesis applying forceps in the end and placing them on the springs around the upper ring (Fig. 5), having good control and order of the stitches. On completion of this stage, the valve is freed from the and holder and placed in situ by supporting pulling the spring bars in each quadrant. (Fig. 6.) Thereafter, the upper ring is removed and the stitches are tied.

ring and through

the prosthesis

and they

are resting

and

FIG. 6. The final maneuver.

American Jownal

of Surgery

Artificial Heart Valve Replacement SUMMARY

AND

CONCLUSIONS

A new artificial valve holder and its technic of application are described. The holder can be used for mitral, tricuspid, and aortic valve reby Starr-Edwards ball valve, placement Hammersmith, or Alvarez prostheses. The application of this technic facilitates the operation and maintains a tidier operative field. Moreover, during aortic valve replacement the two

Vol. 114.

December 1967

977

mobile vises can be used to hold the coronary perfusion cannulas, keeping the aorta open at the same time.

Acknowledgment: I would like to thank Mr. II. G. Taylor, M.B., F.R.C.S., for his advice, Messrs. Chas. F. Thackray, Limited, Leeds, United Kingdom, for their cooperation, and Miss J. E. Baptie for secretarial assistance.