Pulmonary trunk perforation during transapical minimal invasive aortic valve replacement

Objective For elderly patients with symptomatic aortic valve stenosis, aortic valve replacement with tissue valves is still the treatment of choice. Stentless valves were introduced to clinical practice for better hemodynamic features as compared with stented tissue valves. However, the implantation is more complex and time demanding, especially in minimal invasive aortic valve replacement. We present our clinical data on 22 patients having received a sutureless ATS 3f Enable aortic bioprosthesis via partial upper sternotomy. Methods The procedure was performed using CPB with cardioplegic arrest. After resection of the stenotic aortic valve and debridement of the annulus, the valve was inserted and released. Mean age was 79 years, and mean logistic Euroscore was 13. Subvalvular myectomy was performed in two patients. Prosthetic valve sizes were 19 mm (n = 1), 21 mm (n = 7), 23 mm (n = 6), 25 mm (n = 6), and 27 mm (n = 2). Results Implantation of the valve required 10 ± 6 minutes. Cardiopulmonary bypass and aortic crossclamp time were 87 ± 16 and 55 ± 11 minutes, respectively. Early mortality (<90 days) was 9% (2 patients). No paravalvular leakage was detected intraoperatively or in follow-up echocardiography. The mean transvalvular gradients were 9 ± 6 mm Hg at discharge and 8 ± 2 mm Hg at 1-year follow-up. Conclusions Sutureless valve implantation via partial sternotomy is feasible and safe with the ATS 3f Enable bioprosthesis. Reduction of cardiopulmonary bypass and aortic crossclamp time seems possible with increasing experience. Hemodynamic data are very promising with low gradients at discharge and after 12 month. Sutureless valve implantation via minimal invasive access may be an alternative treatment option for elderly patients with high comorbidity.

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P-20 Hyponatraemia after “Bretschneider” cardioplegia during minimal invasive aortic valve replacement

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2011.03.113 ◽

2011 ◽

Vol 25 (3) ◽

pp. S42-S43

Author(s):

Gregor Lindner ◽

Bernhard Zapletal ◽

Michael Hiesmayr ◽

Wilfried Wisser ◽

Andrea Lassnigg

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Minimal Invasive

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Minimal invasive access – the beneficial impact on quality of life for patients undergoing isolated aortic valve replacement

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1246657 ◽

2010 ◽

Vol 58 (S 01) ◽

Cited By ~ 1

Author(s):

H Baumbach ◽

JH Burger ◽

R Nagib ◽

M Albert ◽

A Ursulescu ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Minimal Invasive ◽

Beneficial Impact

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Minimal invasive aortic valve replacement: associations of radiological assessments with procedure complexity

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-0997-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Bruce R. Boti ◽

Vikash G. Hindori ◽

Emilio L. Schade ◽

Athina M. Kougioumtzoglou ◽

Eva C. Verbeek ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Regression Models ◽

Statistical Significance ◽

Minimal Invasive ◽

Suture Technique ◽

Preoperative Imaging ◽

Preoperative Ct ◽

Valve Implantation

Abstract Objectives Limited aortic annulus exposure during minimal invasive aortic valve replacement (mini-AVR) proves to be challenging and contributes to procedure complexity, resulting in longer procedure times. New innovations like sutureless valves have been introduced to reduce procedure complexity. Additionally, preoperative imaging could also contribute to reducing procedure times. Therefore, we hypothesize that Computed Tomography (CT)-image based measurements are associated with mini-AVR complexity. Methods One hundred patients who underwent a mini-sternotomy and had a preoperative CT scan were included. With a CT-based mini-AVR planning tool, we measured access distance, access angle, annulus dimensions, and calcium volume. The associations of these measurements with cardiopulmonary bypass (CPB) time and aortic cross-clamp (AoX) time were assessed using univariable and multivariable regression models. In the multivariable models, these measurements were adjusted for age and suture technique. Results In the univariable regression models, calcium volume and annulus dimensions were associated with longer CPB and AoX time. After adjusting for age and suture technique, increasing calcium volume was still associated with longer CPB (adjusted β-coefficient 0.002, 95%-CI (0.005, 0.019), p-value = 0.002) and AoX time (adjusted β-coefficient 0.010, 95%-CI (0.004, 0.016), p-value = 0.002). However, after adjusting for these confounders, the association between annulus dimensions and procedure times lost statistical significance. Conclusion Increase in calcium volume are associated with longer CPB and AoX times, with age and sutureless valve implantation as independent confounders. In contrast to previous studies, access angle was not associated with procedure complexity.

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