Efficacy of Intraventricular Sponge Placement to Capture Debris in
Aortic Valve Replacement
Abstract
Background: Surgical aortic valve replacement (SAVR) carries the known
risk of shedding debris into the left ventricle during valve leaflet
excision and annulus debridement. Embolization of this debris may have
devastating effects for the patient. While surgeons have developed
methods to mitigate this risk, no data exists as to their efficacy.
Herein, we present the first study that evaluates the efficacy of a
technique for capturing debris during SAVR. Methods: Our group conducted
a prospective case series of 20 patients who underwent SAVR using the
insertion of an intraventricular surgical sponge prior to valve leaflet
excision and annulus debridement to capture debris. Surgical sponges
were grossly, radiographically, and histologically examined for the
presence of cellular and acellular debris to determine the efficacy of
this technique. Results: Of the 20 surgical sponges analyzed, 15 (75%)
specimens registered positivity for cellular and/or acellular debris. 7
(35%) sponges were grossly positive, 15 (75%) were radiographically
positive, and 4 (20%) were histologically positive for calcified debris
on examination. Conclusions: This represents the first study that
objectively evaluates a method used to capture debris in SAVR
procedures. Our results demonstrate a high frequency of debris captured
within intraventricular surgical sponges and confirms the efficacy of
this technique. While this data is promising, numerous additional
approaches exist to capture debris and a best practice standard should
exist across the specialty. In addition, this study does not address the
clinical outcomes associated with this technique. To these ends,
additional data and multicenter collaboration is required.