scholarly journals Aortic Bicuspidy: Clinical Profile and Surgery

2021 ◽  
Vol 07 (10) ◽  
Author(s):  
A. Seghrouchni ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operative Mortality ◽  
Aortic Insufficiency ◽  
Clinical Profile ◽  
Surgical Results ◽  
The Mean ◽  
Outcome Of Surgery

Objective: To study the anatomic-clinical profile of aortic bicuspidy and the outcome of surgery. Patients and Methods: During an 18-year period, 448 patients had aortic valve replacement. Of these, 24 (5.3%) had aortic bicuspidy (AB). The diagnosis of AB was made by echocardiography or during surgery. All patients underwent surgery under extracorporeal circulation. Results: The mean age was 45.2 ± 11.8 years, 14 patients (58.3%) had aortic stenosis and 10 cases (41.7%) had aortic insufficiency, 4 of whom had infective endocarditis. All patients had aortic valve replacement. The operative mortality rate was zero. The mean times of the cardiopulmonary bypass (CPB) and aortic clamping were 99.2 ± 35.4 min and 65.8 ± 24.9 min, respectively. Conclusion: Aortic bicuspidy progresses rapidly and becomes symptomatic in young adults. Despite excellent surgical results, early detection is desirable before complications occur.

Minimally Invasive Transaortic Repair of the Mitral Valve

2011 ◽  
Vol 14 (4) ◽  
pp. 232 ◽  
Author(s):  
Orlando Santana ◽  
Joseph Lamelas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Operative Mortality ◽  
The Mean ◽  
Transaortic Approach

<p><b>Objective:</b> We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.</p><p><b>Methods:</b> From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.</p><p><b>Results:</b> There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.</p><p><b>Conclusion:</b> Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.</p>

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.

Totally endoscopic aortic valve replacement: technique and first experience

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Van Genechten ◽  
J Claessens ◽  
A Kaya ◽  
A Yilmaz
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Blood Loss ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Morbidity And Mortality ◽  
Long Term Results ◽  
Funding Source ◽  
The Mean

Abstract Background Cardiac surgery is still looking for new minimally invasive techniques with less trauma and better cosmetic results. In the field of aortic valve replacement, several types of less invasive procedures were introduced, allowing a reduction in blood loss, infections, ventilation times, morbidity and mortality. The most common technique for minimally invasive aortic valve replacement is the mini-sternotomy approach. In this report, the initial experience with a non-sternotomy approach for aortic valve replacement by means of a totally endoscopic surgical technique is presented. Methods The totally endoscopic aortic valve replacement was carried out in 201 patients (59,7% males, mean age: 71.6±11.7 years) from October 2017 until October 2019. Severe aortic valve stenosis was the surgical indication for all patients, who had a mean EuroSCORE II of 2.35±3.82. The surgery was carried out with the patient in supine position and a standard zero-degree optics was used. A 20 mm working port in the 2nd right intercostal space and two 5 mm trocars gained access to the aorta. After groin cannulation, cardiopulmonary bypass was initiated. Transthoracic aortic cross-clamping followed by antegrade administration of a single shot cold mixed-blood cardioplegia was assessed. The aortotomy was followed by the excision of the stenotic aortic valve and the aortic valve prosthesis was implanted in supra-annular position. After the closure of the aorta, an external pacemaker wire was placed. Results Mean cross-clamp and cardiopulmonary bypass times were 62±14 and 94±25 minutes, respectively. No conversion to a sternotomy was needed. The mean length of stay at the intensive care unit was 69.4±149.6 hours while patients spend 9.6±10 days at the hospital. Due to our new fast track protocol, the mean hospital stay in the last two months was 6.1 days (26 patients, 12.9%). The average postoperative blood loss (24h) was 251±298 mL and the patients were ventilated for 6.9±9 hours. In 10 patients (4.9%), re-exploration in an endoscopic way was needed. None of them had a surgical bleeding focus. No paravalvular leakages were detected at discharge. 69 patients (34.7%) developed atrial fibrillation after surgery. In addition, 10 patients (4.9%) underwent a pacemaker implantation postoperatively whereas 4 patients (1.9%) suffered from a CVA. Finally, the 30-day mortality was 2.0%. Conclusion These results concerning the feasibility and safety of totally endoscopic aortic valve replacement are promising. The aortic cross clamping times are acceptable, and the morbidity and mortality rates are low. Long term results are needed to confirm these initial findings. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital

Prosthesis-Patient Mismatch Causes a Significantly Increased Risk of Operative Mortality in Aortic Valve Replacement

2014 ◽  
Vol 17 (3) ◽  
pp. 127 ◽  
Author(s):  
Muhammad Shahzeb Khan ◽  
Faizan Imran Bawany ◽  
Asadullah Khan ◽  
Mehwish Hussain
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operative Mortality ◽  
Univariate Analysis ◽  
Female Gender ◽  
Valve Prosthesis ◽  
Predictors Of Mortality ◽  
Increased Risk ◽  
Urgent Operation

<p><b>Background:</b> Small aortic prosthesis can lead to prosthesis-patient mismatch (PPM). Implanting such small prosthesis remains a controversial issue. This study was done to investigate whether or not PPM causes an increased operative mortality in aortic valve replacement (AVR).</p><p><b>Methods:</b> Two-hundred-two consecutive patients undergoing primary AVR in a tertiary hospital were included. The sample was grouped according to the aortic valve prosthesis size: ?21 mm (small) and >21 mm (standard). The effect of variables on outcomes was determined by univariate and multivariable regression analyses.</p><p><b>Results:</b> PPM was found significantly more among patients with AVR ? 21mm (<i>P</i> < 0.0001). Moreover, the likelihood of mortality also was significantly higher in these patients (<i>P</i> < 0.0001). Univariate analysis demonstrated small prosthesis size, urgent operation, PPM, female gender, and NYHA Class IV as significant predictors of mortality. Multivariate regression identified female gender, PPM, and urgent operation as the key independent predictors of mortality.</p><p><b>Conclusion:</b> PPM and female gender are significant predictors of mortality. Care should be taken to prevent PPM by implanting larger prosthesis especially in females.</p>

scholarly journals Case Report: - Aortic Valve Replacement due to Aortic Valve Leaflet Perforation after PCI

2020 ◽  
Vol 5 (9) ◽  
pp. 511-513
Author(s):  
Yasser Shaban Mubarak ◽  
MD; Muhammad Hussian Abdel Wahaab, MD
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Intervention ◽  
Aortic Insufficiency ◽  
Iatrogenic Injury ◽  
Valve Leaflet ◽  
Coronary Syndrome ◽  
Aortic Valve Leaflet ◽  
Aortic Leaflet

- Percutaneous Coronary Intervention (PCI) is widely recognized as an effective treatment for Acute Coronary Syndrome (ACS). Inspite of advances in equipment and experience of interventional cardiologist, still there are rare complications occurred [1]. Iatrogenic injury of the aortic valve leaflet is a rare. Aortic insufficiency (AI) after a PCI suggests an iatrogenic valve injury. Aortic leaflet injury is not common but possible complication of PCI. Because of the serious consequences, it should be mentioned in the informed consent. Aortic repair of iatrogenic injury is possible, and it can be performed with excellent clinical and functional midterm results. So, Aortic valve replacement (AVR) is the last option [2].

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