Introduction:
Surgical aortic valve replacement (SAVR) has been the gold standard treatment for severe aortic stenosis for the past several decades and remains one of the most commonly performed operations for the practicing adult cardiac surgeon.1 Despite SAVR being a relatively standard operation, it is not without significant risk to the patient. This risk is attributed to, in part, by the innate invasiveness of the procedure and the comorbidities common within the patient population. SAVR also carries a well-known risk of shedding debris into the left ventricle during aortic valve leaflet excision and annulus debridement. Embolization of this debris into systemic circulation may cause a wide range of complications including ischemic complications of the brain, visceral organs, and extremities.2  Recent meta-analyses concerning early postoperative complications for SAVR indicate that 58% of patients experience a silent brain infarct and 5.1% of patients experience a TIA or stroke as a sequelae of this procedure.2-3 These complications may have devastating effects on the lives of patients, and the surgeon must take it upon themself to mitigate these risks to patients.
Numerous techniques have been developed to capture debris developed during aortic valve leaflet removal and annulus debridement. Most commonly, delicate surgical debridement, left ventricular irrigation with suctioning, and insertion of intraventricular surgical sponges have been employed for this purpose.4 Several additional techniques exist that are often practice specific and the superiority of specific approaches is a contentious and hotly debated topic. Though numerous techniques exist, no objective data currently exists in the literature to address their relative efficacy. The value of these techniques has recently been called into question. For example, our group recently published an ex-vivo porcine model evaluating the efficacy of left ventricle irrigation and careful suctioning to capture debris. Debris of varying density (limestone pieces, pledgets, and tissue) were placed inside the left ventricle (LV) and the LV was thoroughly irrigated and suctioned numerous times. The resulting solutions were filtered and the debris within them was quantified. It was found that the rate of debris capture was relatively low, 43% of pledgets, 17% of limestone, and 9% of tissue pieces were retrieved.4 Given the devastating nature of these complications, the individual and relative efficacy of each technique aimed at capturing calcified debris during SAVR should be objectively evaluated, compared, and a best practice standard should be developed for use across the specialty.
The insertion of a surgical sponge into the left ventricle prior to aortic valve leaflet excision and annulus debridement is a simple and cost-effective method for capturing debris developed during SAVR (Figure 1).5 Herein, we present a prospective case series aimed at objectively evaluating the efficacy of this technique in capturing debris via gross, radiographic, and histological examination of surgical specimens.