scholarly journals Recent advances in aortic valve replacement

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1159 ◽  
Author(s):  
Cristiano Spadaccio ◽  
Khalid Alkhamees ◽  
Nawwar Al-Attar
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Median Sternotomy ◽  
Surgical Aortic Valve Replacement ◽  
Complete Excision ◽  
Surgical Access ◽  
Transcatheter Valve ◽  
Transcatheter Valves

Aortic valve replacement has stood the test of time but is no longer an operation that is exclusively approached through a median sternotomy using only sutured prostheses. Currently, surgical aortic valve replacement can be performed through a number of minimally invasive approaches employing conventional mechanical or bioprostheses as well as sutureless valves. In either case, the direct surgical access allows inspection of the valve, complete excision of the diseased leaflets, and debridement of the annulus in a controlled and thorough manner under visual control. It can be employed to treat aortic valve pathologies of all natures and aetiologies. When compared with transcatheter valves in patients with a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. As our understanding of sutureless valves and their applicability to minimally invasive surgery advances, the invasiveness and trauma of surgery can be reduced and outcomes can improve. This warrants further comparative trials comparing sutureless and transcatheter valves.

scholarly journals Recent advances in aortic valve replacement for aortic stenosis

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2542 ◽  
Author(s):  
Ahmed Al-Adhami ◽  
Nawwar Al-Attar
Keyword(s):  
Minimally Invasive Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Median Sternotomy ◽  
Conventional Surgery ◽  
Recent Advances ◽  
Transcatheter Valve ◽  
Predictive Risk ◽  
Transcatheter Valves

Aortic valve replacement is no longer an operation that is approached solely through a median sternotomy. Recent advances in the fields of transcatheter valves have expanded the proportion of patients eligible for intervention. Comparisons between transcatheter valves and conventional surgery have shown non-inferiority of transcatheter valve implants in patients with a high or intermediate pre-operative predictive risk. With advances in our understanding of sutureless valves and their applicability to minimally invasive surgery, the invasiveness and trauma of surgery can be reduced with potential improvements in outcome. The strategy of care has radically changed over the last decade.

scholarly journals Minimally Invasive Surgical Aortic Valve Replacement: the RALT approach

2020 ◽  
Author(s):  
Karel Van Praet ◽  
Antonia van Kampen ◽  
Markus Kofler ◽  
Gregor Richter ◽  
Simon Suendermann ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Minimally Invasive Surgical

scholarly journals Is it safe to move away from a full sternotomy for aortic valve replacement?

2020 ◽  
Vol 28 (9) ◽  
pp. 553-559
Author(s):  
Ayman Kenawy ◽  
Abdelrahman Abdelbar ◽  
Charlene Tennyson ◽  
Rebecca Taylor ◽  
Joseph Zacharias
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Median Sternotomy ◽  
Statistical Testing ◽  
Categorical Variables ◽  
Surgical Approaches ◽  
Continuous Variables ◽  
Surgical Aortic Valve Replacement ◽  
Right Thoracotomy

Background Minimally invasive surgical approaches have gained popularity among patients and surgeons. The aim of this project was to assess the safety of initiating aortic valve replacement via an anterior right thoracotomy program. Methods Between May 2015 and May 2019, data of all isolated primary aortic valve replacements were extracted retrospectively from our prospectively collected database and categorized into conventional median sternotomy, hemisternotomy, and anterior right thoracotomy cases. In total, 661 patients underwent isolated primary aortic valve replacement, of whom 429 (65%) had a median sternotomy, 126 (19%) had a hemisternotomy, and 106 (16%) had an anterior right thoracotomy. Preoperative characteristics were similar in each of the three groups. Statistical testing of the surgical groups was undertaken using the chi-square test for categorical variables and one-way analysis of variance with Tukey post-hoc pairwise tests (where appropriate) for continuous variables, to identify differences between pairs of data. Results Cardiopulmonary bypass and crossclamp times were significantly longer in the anterior right thoracotomy group compared to the hemisternotomy and median sternotomy groups ( p < 0.001). Blood loss was significantly less and hospital stay significantly shorter in the hemisternotomy group compared to median sternotomy group but not the anterior right thoracotomy group. Mortality, stroke, renal, gastrointestinal and respiratory complications showed no statistical differences. Conclusion Surgical aortic valve replacement had a very low mortality and morbidity in our experience, and it is safe to start a minimal access program for aortic valve replacement.

Transcatheter Aortic Valve Replacements: Current Trends and Future Directions

2018 ◽  
Vol 23 (3) ◽  
pp. 282-292
Author(s):  
Lee A. Goeddel ◽  
Jessica Serini ◽  
Johannes W. Steyn ◽  
Adam S. Evans ◽  
Sanjay Dwarakanath ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
The United States ◽  
Surgical Aortic Valve Replacement ◽  
Future Directions ◽  
Continuous Growth ◽  
Hybrid Techniques ◽  
Transcatheter Aortic Valve ◽  
Surgical Access

Since the 1960s when the first aortic surgical aortic valve replacement (SAVR) was performed, continuous growth in the field of valvular technology has occurred. Although SAVR remains a lifesaving procedure, minimally invasive transcatheter aortic valve replacement has revolutionized and expanded aortic valve replacement to patients who were not previously SAVR candidates, increasing their quality of life and survival. Since its introduction in the United States in 2011, the technology and practice have rapidly expanded. Hybrid techniques have been developed that combine surgical access to the vasculature with valvular deployment over transcatheter systems. This literature review aims to describe the differences between the current available valve technologies, review approaches to surgical technique, discuss anesthetic considerations, and look forward to future directions, trends, and challenges.

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