Room Setup

High-definition monitors should be positioned across from both the surgeon and assistant, allowing the team to view the endoscopic image throughout the procedure.

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Patient Positioning

The optimal patient positioning for the µAVR™ procedure is supine, with both arms tucked and a right infrascapular roll placed to elevate the right hemithorax by approximately 20°.

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multiSTATION™ System Setup‍

Mounted sterile directly to the table rails over the drape, the multiSTATION™ System provides a modular, readily adjustable platform for holding the endoscope and other surgical instruments during the procedure.

Surgical Incision

A small, 4–5 cm microthoracotomy incision in the second intercostal space provides sufficient working space for most patients. Routine preoperative CT imaging enables careful assessment of the patient’s unique anatomy, especially regarding vascular access considerations. A camera port placed below the incision within the same intercostal space provides excellent visualization. Placing the aortic cross-clamp one intercostal space above the incision maximizes working space.

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Pericardial Stay Suture Management

After opening the pericardium, retraction sutures are held using the low-profile RaPort™, which is inserted through the chest wall with a blunt obturator to minimize trauma and bleeding.

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Tensioning Stay Sutures

The miniRUMEL® provides for secure and readily-adjustable control of tension for venous, arterial, and purse string stay sutures.

Aortotomy

A transverse aortotomy ~1-2 cm above the sinotubular junction provides exposure of the aortic annulus.

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Aortic Root Exposure

The AVR NAVIGATOR™ helps expose, align, and fixate the aortic root, facilitating optimal visualization and placing annular tissue under tension for enhanced suturing.

Annular Suturing

The RAM® Device shaft rotates and its tip angulates for ergonomic suture bite placement. Available with either 3.5 or 5.0 mm needle spacing, RAM® uses dual curved needles to place the first half of a horizontal mattress suture with a single squeeze and release of the lever. After each bite, the RAM® sutures are transferred to a SEW-EASY® Cassette for the next step. RAM® annular suturing typically begins at the right coronary sinus, followed by the noncoronary sinus. Subsequent sutures routinely proceed clockwise around the annulus to reduce potential interference with endoscopic visualization.

Prosthetic Suturing

When annular suturing is complete, a single squeeze and release of the SEW-EASY® lever places each suture through the prosthetic valve sewing cuff at bite widths of either 3.5 or 5.0 mm. The assistant typically loads cassettes into the SEW-EASY® Device. The surgeon holds the prosthetic valve on a customized short handle during suture placement in the sewing cuff. This expedited technique enables rapid and precise control of this critical step.

Prosthetic Valve Delivery

The VALVEVAULT™ is offered in 3 sizes to provide 6 customized valve chambers, compatible with a wide variety of popular, clinically-available bioprosthetic valves. MiniRUMELs™ can be used to help seat the valve.

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Suture Securing

The COR-KNOT® promptly, reliably, and ergonomically secures valve sutures while providing clinically demonstrated benefits to patients. The COR-KNOT® Device crimps the clinically proven strong titanium fastener around valve suture replacing manually tied knots on the valve annulus. The COR-KNOT® approach enhances the surgeon’s ability to pursue the preferred “no-touch” principle in valve replacement surgery.