Operative technique
First of all, we designed and constructed our own templates system and
then tested it in experimental surgeries on pig hearts.
After a median sternotomy, the preparation of the pericardium is started
by cleaning it of fat and other redundant tissues on its external
surface. A portion of the patient’s pericardium was harvested and
removed. The excised pericardium was then treated with 0.6%
glutaraldehyde solution with an 8.4% sodium bicarbonate solution for 10
minutes. The treated pericardium was rinsed 3 times using physiologic
saline solution for 6 minutes. Then, to perform AVRec surgery, we
followed the technique described by Ozaki et al in their reports (Figure
1).8,14
All surgeries were performed during cardioplegic arrest on
cardiopulmonary bypass. All patients underwent intraoperative
transesophageal echocardiography in addition to standard monitoring for
cardiac surgery.
According to the American Society of Echocardiography Recommendations,
an advanced trained imaging cardiologist assessed transthoracic and
transesophageal echocardiography.