Partial median „I“ sterntomy – a novel minimal-invasive approach for aortic valve replacement

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
S Wildhirt ◽  
J Boehm ◽  
A Will ◽  
P Libera ◽  
S Martinoff
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Minimal Invasive ◽  
Invasive Approach ◽  
Minimal Invasive Approach

Minimal Invasive and Sutureless Technology: Are These Advantages for Patients Undergoing Aortic Valve Replacement?

2016 ◽  
Vol 64 (S 01) ◽  
Author(s):  
G. Santarpino ◽  
J. Sirch ◽  
J. Kalisnik ◽  
F. Vogt ◽  
S. Pfeiffer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Minimal Invasive

A new mini invasive approach for aortic valve replacement

2005 ◽  
Vol 53 (S 3) ◽  
Author(s):  
F Siclari ◽  
S Demertzis ◽  
R Trunfio ◽  
R Mauri ◽  
T Cassina
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Invasive Approach

Minimally invasive redo aortic valve replacement with a sutureless valve implant

2021 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Valve Prosthesis ◽  
Mechanical Prosthesis ◽  
Invasive Approach ◽  
Replacement Procedure ◽  
Aortic Valve Prosthesis ◽  
Sutureless Valve

Reoperations for a dysfunctional mechanical aortic valve prosthesis are usually performed with a repeat sternotomy. Reopening the chest may be associated with a heart structure tear, bleeding, excessive transfusion, and a possible unfavorable outcome. Experience performing a redo aortic valve replacement with a minimally invasive approach and avoiding lysis of the pericardial adhesions is growing. We describe a redo aortic valve replacement procedure performed because of subvalvular pannus formation in a patient with a mechanical prosthesis. A partial J-shaped hemisternotomy at the 3rd intercostal space was performed; the ascending aorta was exposed and the valve was replaced with a sutureless bioprosthesis. The video tutorial shows the surgical approach, cardiopulmonary bypass solutions, and sutureless valve deployment.

Abstract 16138: Validation of a Non-invasive Approach for the Assessment of Left Ventricular-arterial Coupling Following Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emad Mogadam ◽  
David Shavelle ◽  
Jing Liu ◽  
Gregory Giesler ◽  
Ray Matthews ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Systolic Function ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Arterial Elastance ◽  
Invasive Approach ◽  
Transcatheter Aortic Valve

Introduction: Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe, symptomatic aortic stenosis (AS). Ventriculoarterial (LV-arterial) coupling defined as the ratio of total arterial elastance (Ea) to left ventricular end-systolic elastance (Ees) reflects effective cardiac energetics and is a well-accepted index for quantification of LV-arterial coupling. Despite its usefulness, estimating Ees/Ea has technical difficulties. Intrinsic Frequency (IF) method is a noninvasive and single waveform system-based approach for quantification of LV-arterial coupling. The objective of this study was to compare IF variables with Ea/Ees in predicting optimum LV-arterial energetics following TAVR. Method: Twenty-eight patients with severe AS, undergoing TAVR were included. Mean age was 85±4, 53% male with mean ejection fraction 59±6.4. IFs during systole (ω1), diastole (ω2), and total IF variation (Δω=ω1-ω2) were computed from the ascending aortic pressure waveforms at baseline and following TAVR. Ea/Ees was computed using single-beat technique proposed by Takeuchi et al. ( Circulation . 1991;83(1):202-212). Results: There was a significant decrease in Ea/Ees (p<0.001) toward optimum coupling immediately after TAVR (Figure 1a). There was a statistically significant correlation between Ea/Ees and Δω (r= 0.68, p<0.01) (Figure 1b). Conclusion: IF appears to be an accurate and reliable index for quantification of LV-arterial coupling given significant concordance with Ea/Ees. The management of patients with acutely altered hemodynamic states post TAVR can benefit from the assessment of LV-arterial coupling. Since IFs can be measured noninvasively using hand-held devices (e.g. an iPhone), this approach should broaden the clinical applicability of this useful parameter for assessing systolic function, therapeutic response and ventricular-arterial interaction post TAVR.

scholarly journals Full sternotomy and minimal access approaches for surgical aortic valve replacement: a multicentre propensity-matched study

2019 ◽  
Author(s):  
Domenico Paparella ◽  
Pietro Giorgio Malvindi ◽  
Giuseppe Santarpino ◽  
Marco Moscarelli ◽  
Piero Guida ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Propensity Scores ◽  
Mortality Rates ◽  
Minimal Access ◽  
Surgical Aortic Valve Replacement ◽  
Multivariable Logistic Regression Model ◽  
Invasive Approach ◽  
National Cohort

Abstract OBJECTIVES Surgical aortic valve replacement (AVR) can be performed via a full sternotomy or a minimal access approach (mini-AVR). Despite long-term experience with the procedure, mini-AVR is not routinely adopted. Our goal was to compare contemporary outcomes of mini-AVR and conventional AVR in a large multi-institutional national cohort. METHODS A total of 5801 patients from 10 different centres who had a mini-AVR (2851) or AVR (2950) from 2011 to 2017 were evaluated retrospectively. Standard aortic prostheses were used in all cases. The use of the minimally invasive approach has increased over the years. The primary outcome is the incidence of 30-day deaths following mini-AVR and AVR. Secondary outcomes are the occurrence of major complications following both procedures. Propensity-matched comparisons were performed based on the multivariable logistic regression model. RESULTS In the overall population patients who had AVR had an increased surgical risk based on the EuroSCORE, and the 30-day mortality rate was higher (1.5% and 2.3% in mini-AVR and AVR, respectively; P = 0.048). Propensity scores identified 2257 patients per group with similar baseline profiles. In the matched groups, patients who had mini-AVR, despite longer cardiopulmonary bypass (81 ± 32 vs 76 ± 28 min; P = 0.004) and cross-clamp (64 ± 24 vs 59 ± 21 min; P ≤ 0.001) times, had lower 30-day mortality rates (1.2% vs 2.0%; P = 0.036), reduced low cardiac output (0.8% vs 1.4%; P = 0.046) and reduced postoperative length of stay (9 ± 8 vs 10 ± 7 days; P = 0.004). Blood transfusions (36.4% vs 30.8%; P ≤ 0.001) and atrial fibrillation (26.0% vs 21.5%, P ≤ 0.001) were higher in patients who had the mini-AVR. CONCLUSIONS In a large multi-institutional recent cohort, minimal access approach aortic valve replacement is associated with reduced 30-day mortality rates and shorter postoperative lengths of stay compared to standard sternotomy. A prospective randomized trial is needed to overcome the possible biases of a retrospective study.

scholarly journals Pulmonary trunk perforation during transapical minimal invasive aortic valve replacement

2009 ◽  
Vol 35 (6) ◽  
pp. 1094-1095 ◽  
Author(s):  
Justus T. Strauch ◽  
Elmar Kuhn ◽  
Peter L. Haldenwang ◽  
Thorsten Wahlers
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Minimal Invasive ◽  
Pulmonary Trunk

Sutureless Aortic Valve Replacement via Partial Sternotomy

2010 ◽  
Vol 5 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Sven Martens ◽  
Andreas Zierer ◽  
Anja Ploss ◽  
Sami Sirat ◽  
Aleksandra Miskovic ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Elderly Patients ◽  
Valve Replacement ◽  
Minimal Invasive ◽  
Partial Sternotomy ◽  
Sutureless Valve ◽  
Valve Implantation

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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