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.