scholarly journals Anatomical circumstances and aortic cross-clamp time in minimally invasive aortic valve replacement

2020 ◽  
Author(s):  
Jure Jug ◽  
Zdravko Štor ◽  
Borut Geršak
Keyword(s):  
Aortic Valve ◽  
Linear Regression ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Linear Regression Model ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Cross Clamp Time ◽  
The Right

Abstract OBJECTIVES Prolonged operative times, potentially leading to increased morbidity, are a possible drawback of minimally invasive aortic valve replacement. The aim of this study was to assess the impact of anatomical circumstances in the chest on aortic cross-clamp time. METHODS This retrospective study included 68 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve via right-anterior thoracotomy or with ministernotomy. Anatomical variables were measured during preoperative computer tomography scans. RESULTS Aortic cross-clamp time was shorter in those having ministernotomy than in the right-anterior thoracotomy group (41.1 vs 52.3 min; P < 0.001). Cardiopulmonary bypass (CPB) time was not significantly different between groups (P = 0.09). A multivariable linear-regression model (P = 0.018) showed the aortic dextroposition variable to be a significant predictor of the aortic cross-clamp method and CPB times (P = 0.005 and P = 0.003) independent of other anatomical variables in the right thoracotomy group (10 mm deviation from optimal position prolonged the times for 240 and 600 s). For the whole cohort, a correlation between aortic valve dimensions and operative times was found (P = 0.046, P = 0.009). A linear-regression model (P = 0,046) predicted 90 s longer aortic cross-clamp time and 231 s longer CPB time for every 1 mm smaller aortic valve diameter. CONCLUSIONS The anatomical variables are associated with the operative times in minimally invasive aortic valve replacement with sutureless valves. Considering this association, preplanning the procedure is recommended.

scholarly journals Continuous Suture Technique for Aortic Valve Replacement Shortens Cross-Clamp and Bypass Times

2017 ◽  
Vol 44 (6) ◽  
pp. 390-394 ◽  
Author(s):  
Tadashi Kitamura ◽  
James Edwards ◽  
Kagami Miyaji
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Suture Technique ◽  
Paravalvular Leak ◽  
Continuous Suture ◽  
Surgical Aortic Valve Replacement ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Cross Clamp Time

The interrupted noneverting mattress suture technique is typically used in conventional surgical aortic valve replacement. The continuous suture technique, although faster, has been associated with a higher incidence of paravalvular leak. Using a slightly modified technique to minimize this risk, we investigated whether continuous suturing would shorten aortic cross-clamp time in aortic valve replacement in comparison with interrupted suturing. We reviewed the cases and compared the perioperative data of 60 consecutive patients in Japan and Australia (35 men and 25 women; median age, 70 yr) who had undergone aortic valve replacement with or without septal myectomy. The continuous suture technique had been used in 41 patients (Group CS) and the standard interrupted suture technique in 19 (Group IS). The groups were similar in age, sex, pathologic valvular conditions, and operative urgency. In Group CS, aortic cross-clamp time (47 vs 63 min; P=0.0001) and cardiopulmonary bypass time (76 vs 89 min; P=0.04) were significantly shorter. Neither group had early paravalvular leak. Using our continuous suture technique safely shortened aortic cross-clamp time during surgical aortic valve replacement.

Minimally Invasive Aortic Valve Replacement via Right Anterior Minithoracotomy and Central Aortic Cannulation

2017 ◽  
Vol 12 (2) ◽  
pp. 87-94 ◽  
Author(s):  
Daniel M. Bethencourt ◽  
Jennifer Le ◽  
Gabriela Rodriguez ◽  
Robert W. Kalayjian ◽  
Gregory S. Thomas
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Aortic Cross Clamp ◽  
Bonferroni Adjustment ◽  
The Mean ◽  
Central Cannulation

Objective This study reports the evolution of a minimally invasive aortic valve replacement (mini-AVR) technique that uses a right anterior minithoracotomy approach with central cannulation, for a 13-year period. This technique has become our standard approach for isolated primary AVR in nearly all patients. Methods This observational study evaluated perioperative clinical outcomes of patients 18 years or older who underwent mini-AVR from November 2003 to June 2015. Results The mini-AVR technique was used in 202 patients during two periods of 2003 to 2009 (n = 65, “early”) and 2010 to 2015 (n = 137, “late”). The mean ± SD age was 72.5 ± 12.9 years and 60% were male. Demographic parameters were statistically similar between the study periods, except for increased body weight in the later period (75.3 ± 14.7 vs 80.9 ± 20.8 kg, P = 0.03). The mean cardiopulmonary bypass and aortic cross-clamp times were significantly different by each year and Bonferroni adjustment, with significant decreases in cardiopulmonary bypass and aortic cross-clamp times beginning 2006. Compared with the early study period, late study period patients were more often extubated intraoperatively (52% vs 12%, P < 0.001), had less frequent prolonged ventilator use postoperatively (6% vs 16%, P = 0.018), required fewer blood transfusions (mean, 2.0 ± 2.3 U vs 3.6 ± 3.0 U; P = 0.011), and had shorter postoperative stay (6.3 ± 4.5 days vs 8.0 ± 5.9 days, P = 0.026). Numerically, fewer postoperative strokes (1% vs 6%, P = 0.09) and fewer reoperations for bleeding (3% vs 6%, P = 0.3) occurred in the late period. In-hospital mortality did not differ (1/65 early vs 3/137 late). Conclusions Overall mini-AVR intraoperative and postoperative clinical outcomes improved for this 13-year experience.

Rescue Balloon Aortic Valvuloplasty After Sutureless Aortic Valve Replacement for Severe Paravalvular Leak

2019 ◽  
Vol 14 (5) ◽  
pp. 476-479 ◽  
Author(s):  
Eiki Nagaoka ◽  
Keita Sato ◽  
Ali Hage ◽  
Rodrigo Bagur ◽  
Christopher Harle ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
New Technology ◽  
Balloon Valvuloplasty ◽  
Paravalvular Leak ◽  
Aortic Cross Clamp ◽  
Balloon Aortic Valvuloplasty ◽  
Sutureless Valve ◽  
The Right

Sutureless aortic valve replacement (AVR) is a wide-spreading new technology that provides short clamping time and excellent hemodynamic outcomes. However, among its possible complications is the risk of paravalvular leak. We present the case of a 63-year-old woman who underwent minimally invasive right mini-thoracotomy AVR) with Perceval S sutureless valve (LivaNova, London, UK). Intraoperative transesophageal echocardiography revealed severe paravalvular leak with stent distortion. Rescue balloon valvuloplasty was performed through the right femoral artery, and resulted in the resolution of the paravalvular leak. This case illustrates the utility and feasibility of balloon valvuloplasty in trouble-shooting sutureless aortic valve stent distortion, thus avoiding a repeat aortic cross-clamp and valve replacement.

Easy Placement of Annular Sutures during Minimally Invasive Aortic Valve Replacement

2017 ◽  
Vol 12 (3) ◽  
pp. 227-229 ◽  
Author(s):  
Toshinori Totsugawa ◽  
Arudo Hiraoka ◽  
Kentaro Tamura ◽  
Hidenori Yoshitaka ◽  
Taichi Sakaguchi
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Surgical Field ◽  
Coronary Cusp ◽  
Hemodynamic Performance ◽  
The Right ◽  
Right Coronary Cusp

Placing annular sutures at the right coronary cusp is difficult during minimally invasive aortic valve replacement. We propose the partial everting mattress method, whereby a prosthetic valve is implanted ina supra-annular position at the left coronary and noncoronary cusps, with pledgets on the left ventricular side, but in an intra-annular position at the right coronary cusp, with pledgets on the aortic side. Needles can be grasped in forehand pass at all three coronary cusps. Our method enables easy placement of annular stitches even in the small surgical field, without adversely influencing the hemodynamic performance of the prosthesis.

scholarly journals International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

2016 ◽  
Vol 11 (3) ◽  
pp. 165-173 ◽  
Author(s):  
Mattia Glauber ◽  
Simon C. Moten ◽  
Eugenio Quaini ◽  
Marco Solinas ◽  
Thierry A. Folliguet ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Aortic Cross Clamp Time ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Attractive Option ◽  
Rapid Deployment ◽  
International Experts

Objective To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement. Methods A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach. Results No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed to-mographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs. Conclusions Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.

scholarly journals Minimally Invasive versus Conventional Aortic Valve Replacement: A Propensity-Matched Study from the UK National Data

2016 ◽  
Vol 11 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Rizwan Q. Attia ◽  
Graeme L. Hickey ◽  
Stuart W. Grant ◽  
Ben Bridgewater ◽  
James C. Roxburgh ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Cohort Analysis ◽  
Cross Clamp Time ◽  
Significant Difference ◽  
Postoperative Length

Objective Minimally invasive aortic valve replacement (MIAVR) has been demonstrated as a safe and effective option but remains underused. We aimed to evaluate outcomes of isolated MIAVR compared with conventional aortic valve replacement (CAVR). Methods Data from The National Institute for Cardiovascular Outcomes Research (NICOR) were analyzed at seven volunteer centers (2006–2012). Primary outcomes were in-hospital mortality and midterm survival. Secondary outcomes were postoperative length of stay as well as cumulative bypass and cross-clamp times. Propensity modeling with matched cohort analysis was used. Results Of 307 consecutive MIAVR patients, 151 (49%) were performed during the last 2 years of study with a continued increase in numbers. The 307 MIAVR patients were matched on a 1:1 ratio. In the matched CAVR group, there was no statistically significant difference in in-hospital mortality [MIAVR, 4/307,(1.3%); 95% confidence interval (CI), 0.4%-3.4% vs CAVR, 6/307 (2.0%); 95% CI, 0.8%-4.3%; P = 0.752]. One-year survival rates in the MIAVR and CAVR groups were 94.4% and 94.6%, respectively. There was no statistically significant difference in midterm survival (P = 0.677; hazard ratio, 0.90; 95% CI, 0.56–1.46). Median postoperative length of stay was lower in the MIAVR patients by 1 day (P = 0.009). The mean cumulative bypass time (94.8 vs 91.3 minutes; P = 0.333) and cross-clamp time (74.6 vs 68.4 minutes; P = 0.006) were longer in the MIAVR group; however, this was significant only in the cross-clamp time comparison. Conclusions Minimally invasive aortic valve replacement is a safe alternative to CAVR with respect to operative and 1-year mortality and is associated with a shorter postoperative stay. Further studies are required in high-risk (logistic EuroSCORE > 10) patients to define the role of MIAVR.

Two Alternative Sutureless Strategies for Aortic Valve Replacement

2013 ◽  
Vol 8 (4) ◽  
pp. 253-257 ◽  
Author(s):  
Giovanni Concistrè ◽  
Giuseppe Santarpino ◽  
Steffen Pfeiffer ◽  
Pierandrea Farneti ◽  
Antonio Miceli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
New Technology ◽  
Paravalvular Leak ◽  
Aortic Cross Clamp Time ◽  
Invasive Approach ◽  
The Mean

Objective Important comorbid conditions in patients referred for aortic valve replacement (AVR) require less invasive strategies. We describe our initial experience with the Perceval S (Sorin Group, Saluggia, Italy) and 3f Enable (Medtronic, Minneapolis, MN USA) sutureless aortic bioprostheses. Methods We compared intraoperative data, postoperative clinical outcomes, and echocardiographic results from patients receiving a Perceval S ( P group; n = 97) or a 3f Enable (E group; n = 32) prosthesis in two cardiac surgery departments (Nuremberg, Germany, and Massa, Italy). Results Baseline patient characteristics were similar in both groups, except for mean ± SD body surface area ( P group = 2.01 ± 2.9 m2, E group = 1.83 ± 3.8 m2; P < 0.001). Sixty-five patients (67%) in the P group and 19 patients (59.5%) in the E group ( P = 0.22) underwent minimally invasive AVR with either ministernotomy or right anterior minithoracotomy approach. Concomitant procedures were performed in 37 patients (38%) in the P group and 9 patients (28%) in the E group ( P = 0.56). In-hospital mortality was 2%. The mean ± SD prosthesis diameter was 23.5 ± 1.4 mm ( P group) compared with 22.1 ± 2 mm (E group) ( P < 0.001). In isolated AVR, aortic cross-clamp time was 36 ± 12.7 minutes in the P group and 66 ± 18 minutes in the E group ( P < 0.001). At a mean ± SD follow-up of 8.3 ± 4.5 months, survival was 97% (one death in the P group). In five patients ( P group = 1, E group = 4), a moderate paravalvular leak was present ( P = 0.013). The mean ± SD transvalvular gradient was 9.1 ± 3.3 mm Hg with the Perceval S and 11.2 ± 5.2 mm Hg with the 3f Enable ( P = 0.017). Conclusions Aortic valve replacement with sutureless aortic bioprosthesis is feasible, also with a minimally invasive approach. The Perceval S showed lower operative times and moderate paravalvular leaks and lower mean transvalvular gradients than did the 3f Enable, related to the larger diameter of the Perceval S implanted. Both prostheses showed an excellent hemodynamic performance. This new technology needs long-term follow-up.

Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Minithoracotomy for All Comers With Aortic Valve Disease

2020 ◽  
pp. 155698452097721
Author(s):  
Farhad Bakhtiary ◽  
Ali El-Sayed Ahmad ◽  
Mohamed Amer ◽  
Saad Salamate ◽  
Sami Sirat ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Paravalvular Leak ◽  
Ischemic Time ◽  
Video Assisted ◽  
The Right

Objective Right anterior minithoracotomy is a promising technique for aortic valve replacement and has shown excellent results in terms of mortality and morbidity. Against this background, we analyzed our institutional experience in this technique during the last 3 years. Methods Between April 2017 and March 2019, 513 consecutive all comers with aortic valve disease underwent video-assisted minimally invasive aortic valve replacement through a 3-cm skin incision as right anterior minithoracotomy at our institution. A camera and automatic fastener technology were used for the valve implantation in all patients. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time accounted for 68 ± 24 min and the myocardial ischemic time 38 ± 12 minutes. Thirty-day mortality and overall mortality was 0.4% (2 patients) and 1.4% (7 patients), respectively. Postoperative cerebrovascular events were noted in 8 patients (1.5%). Intensive care stay and hospital stay were 2 ± 2 and 9 ± 7 days, respectively. Pacemaker implantation, injury of the right internal mammary artery, and conversion to full sternotomy were noted in 7 patients (1.4%), 3 patients (0.6%), and 1 patient (0.2%), respectively. Paravalvular leak need to intervention was noted in 2 patients (0.4%). Rethoracotomy rate was 2% (11 patients). Transient postoperative dialysis was necessary for 14 patients (3%). Conclusions Video-assisted minimally invasive aortic valve replacement through the right anterior minithoracotomy is a safe approach and yields excellent outcomes in high-volume centers. The use of a camera and automatic fastener technology facilitates this procedure.

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