Asan Medical Center Achieves World's First Success in 3D Full Endoscopic Aortic Valve Re-Replacement Surgery

Minimally Invasive Surgery for Octogenarian Patient
Achieved by Professors Yoo Jaeseok and Park Deokwoo's Team

The medical team at Asan Medical Center in Seoul has become the first in the world to successfully perform a highly complex 'aortic valve re-replacement surgery' using a three-dimensional (3D) fully endoscopic approach.

Professor Yoo Jaeseok, Department of Cardiovascular and Thoracic Surgery, Asan Medical Center, Seoul (left), and Professor Park Deokwoo, Department of Cardiology. Asan Medical Center, Seoul

On August 18, Asan Medical Center announced that the team led by Professor Yoo Jaeseok of the Department of Cardiovascular and Thoracic Surgery and Professor Park Deokwoo of the Department of Cardiology had successfully performed a minimally invasive aortic valve re-replacement surgery using 3D full endoscopy. The procedure was carried out on an 85-year-old male patient who developed valve degeneration seven years after undergoing transcatheter aortic valve implantation (TAVI). The team removed and implanted an artificial valve with minimal invasiveness. The entire surgery took less than two hours, and the patient was discharged in good health after nine days.

For elderly or severe aortic stenosis patients whose aortic valves have become calcified and narrowed, TAVI is commonly performed, replacing the aortic valve with an artificial one via a stent. However, about a decade after TAVI, the artificial valve may reach the end of its lifespan or the vessel may narrow again, requiring re-treatment. In cases where complications such as valve degeneration, paravalvular leakage, or infection occur, aortic valve re-replacement surgery becomes necessary.

Aortic valve re-replacement surgery is a highly complex procedure that involves both removing the existing artificial valve and implanting a new one. Because the previously implanted artificial valve is often strongly adhered to surrounding tissue, open-chest surgery has traditionally been required. However, open-chest surgery involves a long recovery period, so elderly or high-risk patients with comorbidities often forgo surgery and instead manage symptoms with medication alone.

3D full endoscopic heart surgery requires only a 3 to 4 cm incision-much smaller than the 6 to 8 cm incision of conventional minimally invasive heart surgery. Through this small incision, a 3D camera-equipped endoscope is inserted, and the surgeon, wearing special glasses, performs the operation using instruments while viewing the 3D images transmitted by the camera. This allows the surgeon to visually perceive depth and thickness inside the body and provides high-resolution imaging. The significantly smaller incision shortens recovery time, and because there is no bone cutting, postoperative pain is reduced, lessening both the psychological and physical burden on the patient. The medical team also notes that the cure rate is equivalent to that of open-chest surgery.

Until recently, 3D full endoscopic heart surgery was applied only to mitral valve repair, but its indications are gradually expanding to include aortic valve replacement, cardiac tumor surgery, atrial septal defect repair, and atrial fibrillation surgery.

Professor Park Deokwoo stated, "In cases where re-treatment is needed after TAVI, valve-in-valve TAVI is sometimes performed, but for elderly and high-risk patients for whom repeat procedures are anatomically difficult, minimally invasive surgery using 3D full endoscopy is extremely beneficial." Professor Yoo Jaeseok commented, "Elderly and high-risk patients often gave up on surgery altogether due to the burden of open-chest procedures, but we expect that this new 3D full endoscopic approach will offer an excellent alternative."

This world's first successful aortic valve re-replacement surgery using 3D full endoscopy was recently published in the Journal of the American College of Cardiology: Case Reports (JACC: Case Reports). Professor Yoo has also been invited as a speaker to the Endoscopic Cardiac Surgeons Club, which will be held in Cincinnati, USA, next month.

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