scholarly journals Minimally Invasive Device Repair of Ascending Aortic Pathology in Selected High-Risk Patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Debin Liu ◽  
Hong Wang ◽  
Yongnan Li ◽  
Qi Ma ◽  
Weifang Wang ◽  
...  
Keyword(s):  
High Risk ◽  
Minimally Invasive ◽  
High Risk Patients ◽  
Aortic Pathology ◽  
Risk Patients ◽  
Invasive Device ◽  
Minimally Invasive Device

Minimally Invasive Direct Coronary Artery Bypass in High-Risk Patients with Multivessel Disease

2021 ◽  
Author(s):  
Grischa Hoffmann ◽  
Christine Friedrich ◽  
Katharina Huenges ◽  
Rainer Petzina ◽  
Astrid-Mareike Vogt ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background High-risk patients with multivessel disease (MVD) including a complex stenosis of the left anterior descending coronary may not be ideal candidates for guideline compliant therapy by coronary artery bypass grafting (CABG) regarding invasiveness and perioperative complications. However, they may benefit from minimally invasive direct coronary artery bypass (MIDCAB) grafting and hybrid revascularization (HCR). Methods A logistic European system for cardiac operative risk evaluation score (logES) >10% defined high risk. In high-risk patients with MVD undergoing MIDCAB or HCR, the incidence of major adverse cardiac and cerebrovascular events (MACCEs) after 30 days and during midterm follow-up was evaluated. Results Out of 1,250 patients undergoing MIDCAB at our institution between 1998 and 2015, 78 patients (logES: 18.5%; age, 76.7 ± 8.6 years) met the inclusion criteria. During the first 30 days, mortality and rate of MACCE were 9.0%; early mortality was two-fold overestimated by logES. Complete revascularization as scheduled was finally achieved in 64 patients (82.1%). Median follow-up time reached 3.4 (1.2–6.5) years with a median survival time of 4.7 years. Survival after 1, 3, and 5 years was 77, 62, and 48%. Conclusion In high-risk patients with MVD, MIDCAB is associated with acceptable early outcome which is better than predicted by logES. Taking the high-risk profile into consideration, midterm follow-up showed satisfying results, although scheduled HCR was not realized in a relevant proportion. In selected cases of MVD, MIDCAB presents an acceptable alternative for high-risk patients.

Sutureless Aortic Valve Implantation through an Upper V-Type Ministernotomy: An Innovative Approach in High-Risk Patients

2013 ◽  
Vol 8 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Giovanni Concistrè ◽  
Antonio Miceli ◽  
Francesca Chiaramonti ◽  
Pierandrea Farneti ◽  
Stefano Bevilacqua ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Mean ◽  
Valve Implantation

Objective Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients. Methods Between May 2010 and May 2011, thirteen patients with severe aortic stenosis underwent aortic valve replacement with the 3f Enable bioprosthesis through an upper V-type ministernotomy interrupted at the second intercostal space. The mean ± SD age was 77 ± 3.9 years (range, 72–83 years), 10 patients were women, and the mean ± SD logistic EuroSCORE was 15% ± 13.5%. Echocardiography was performed preoperatively, at postoperative day 1, at discharge, and at follow-up. Clinical data, adverse events, and patient outcomes were recorded retrospectively. The median follow-up time was 4 months (interquartile range, 2–10 months). Results Most of the implanted valves were 21 mm in diameter (19–25 mm). The CPB and ACC times were 100.2 ± 25.3 and 66.4 ± 18.6 minutes. At short-term follow-up, the mean ± SD pressure gradient was 14 ± 4.9 mm Hg; one patient showed trivial paravalvular leakage. No patients died during hospital stay or at follow-up. Conclusions The 3f Enable sutureless bioprosthesis implanted in minimally invasive approach through an upper V-type ministernotomy is a feasible, safe, and reproducible procedure. Hemodynamic and clinical data are promising. This innovative approach might be considered as an alternative in high-risk patients. Reduction of CPB and ACC time is possible with increasing of experience and sutureless evolution of actual technology.

scholarly journals Minimally invasive valve surgery in high-risk patients

2017 ◽  
Vol 9 (S7) ◽  
pp. S614-S623 ◽  
Author(s):  
Orlando Santana ◽  
Steve Xydas ◽  
Roy F. Williams ◽  
S. Howard Wittels ◽  
Evin Yucel ◽  
...  
Keyword(s):  
High Risk ◽  
Minimally Invasive ◽  
Valve Surgery ◽  
High Risk Patients ◽  
Risk Patients ◽  
Minimally Invasive Valve Surgery

Combined PCI and minimally invasive heart valve surgery for high-risk patients

2009 ◽  
Vol 11 (6) ◽  
pp. 492-498 ◽  
Author(s):  
Ramanan Umakanthan ◽  
Marzia Leacche ◽  
Michael R. Petracek ◽  
David X. Zhao ◽  
John G. Byrne
Keyword(s):  
High Risk ◽  
Minimally Invasive ◽  
Heart Valve ◽  
Valve Surgery ◽  
Heart Valve Surgery ◽  
High Risk Patients ◽  
Risk Patients
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