Question 1

What is A-View?

Accepted Answer

A-View is a catheter with attached balloon that is introduced into the trachea. The balloon is filled with a sterile saline solution that conducts the sound waves. This makes it possible to visualize the aorta through the trachea, using transoesophageal echocardiography (TOE).

Question 2

What are the advantages of A-View?

Accepted Answer

A-View provides specialists with the ability to visualize the risk area for atherosclerosis, the aorta, prior to cardiac surgery. Also, with A-View the part of the aorta behind the trachea, as seen from the oesophagus, becomes visible. This part of the aorta in particular may hold risky calcifications. After the patient has been anesthetized and connected to the ventilator, the A-View is introduced and the relevant part of the aorta is visualized in its entirety using ultrasound.

Question 3

What is atherosclerosis in cardiac surgery?

Accepted Answer

Atherosclerosis is often the cause of a stroke after open-heart surgery, as a result of connecting the heart-lung machine to the aorta during surgery. This machine has a sandblasting effect on the inner wall of the blood vessel, leading to detachment of atherosclerosis, which is then released, into the bloodstream. The probability that these particles will flow towards the brain is significant. The risk of a stroke in heart-valve surgery that is performed from the groin, is reduced by A-View too.

Question 4

What does A-View contribute to the treatment method?

Accepted Answer

If atherosclerosis is detected, an appropriate surgical technique may be chosen to prevent a stroke. Adjustment of the surgical procedure may include: inserting the cannula at a different place, operating from a different location, performing the operation without a heart-lung machine, and using a cannula of a different design and / or applying less pressure.

Question 5

Is A-View safe?

Accepted Answer

A-View is very safe to use. A-View is CE certified. A-View has a dual system to monitor balloon pressure. Manually, by the pilot balloon, and visually, by connecting a manometer to the standard luer-lock stopcock. On average, the procedure takes less than three minutes. By using a swivel Y-connector, it is possible to ventilate the patient while the A-View is introduced.

Question 6

Is A-View user-friendly?

Accepted Answer

A-View is very safe to use. A-View is CE certified. A-View has a dual system to monitor balloon pressure. Manually, by the pilot balloon, and visually, by connecting a manometer to the standard luer-lock stopcock. On average, the procedure takes less than three minutes. By using a swivel Y-connector, it is possible to ventilate the patient while the A-View is introduced.

Question 7

Why is there training?

Accepted Answer

The ‘Isala Academie’ (a department within the Isala clinics in Zwolle, The Netherlands), the knowledge and expertise center for professionals in- and outside the health-care sector, offers a short course on how to apply this method. The training consists of an accredited web lecture and a ‘Training on the Job’ section. The web lecture includes an overview of the anatomy of the upper mediastinum, a theoretical section on how A-View works, and the definition of atherosclerosis in the ascending aorta. ‘Training on the Job’ teaches the specialist how to use A-View and how to interpret the images obtained with TOE, including the now visible ‘blind spot’. ‘Training on the Job’ can also be realized at the location where the specialist works. Successful completion of the theoretical section of the program ‘A-View Advanced Course’ is required to access the ‘Training on the Job’ section. The NVA and NVVC have accredited the theoretical part for 4 hours. An application for accreditation for the ‘Training on the Job’ by these organizations is pending.

Question 8

Is examination by the CT scan a better examination?

Accepted Answer

The major disadvantage of non-real-time examination, such as CT, is that no point-of-care information is provided, in particular not on the moving components, whereas echography does provide this information. CT does provide information on calcification but not on soft or ulcerated atherosclerotic debris-holding plaques. A CT scan is expensive and has the burden of radiation. This type of examination may also lead to underestimation, while the situation is often worse than expected.

Question 9

Can the aorta be manually checked during surgery?

Accepted Answer

The worst and most dangerous method is perioperative manual palpation; this is completely ineffective, if not dangerous. The surgeon may feel hardening on the outer wall, but gets no information on what is present inside the aorta. Also, it is impossible to feel soft plaques in the inner wall of a normal-walled artery. Furthermore, this method may cause emboli by compressing the aorta.

Question 10

Does epi-aortic ultrasound work better than TOE when combined with A-View?

Accepted Answer

The big disadvantage is that epi-aortic ultrasound can only takes place after sternotomy. Therefore, adjusting the surgical strategy is difficult. Using epi-aortic ultrasound is difficult, since it must be applied in a surgically sterile field.

A-View advanced user guidance