Treatment of Severe Aortic Stenosis: Development and Feasibility Testing of an Aortic Valve Bypass Apical Cannula

2011 ◽  
Author(s):  
Joel D. Graham ◽  
M. Keith Sharp ◽  
Steven C. Koenig ◽  
Guruprasad Giridharan ◽  
Michael A. Sobieski ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
The Elderly ◽  
Mortality Rates ◽  
Cardiovascular Medicine ◽  
Descending Aorta ◽  
Surgical Risk ◽  
Aortic Valve Bypass

Treatment of aortic stenosis through surgical replacement has been one of the most successful advances in cardiovascular medicine (1), though use in certain patient populations, specifically in the elderly, has been associated with increased mortality rates (2). A growing alternative surgery is Aortic Valve Bypass (AVB). This therapy offers decreased surgical risk because it does not require cardiopulmonary bypass, aortic crossclamping, aortotomy, or cardioplegic cardiac arrest (3). A one-way conduit between the apex of the left ventricle and the descending aorta increases flow by reducing afterload (Fig. 1, LEFT). Systolic blood from the left ventricle is ejected via both the native stenotic aortic valve and the AVB circuit. In this feasibility study, an apical cannula was developed and tested.

scholarly journals Experience with Percutaneous Aortic Valve Implantation in Patients with Severe Aortic Stenosis at High Surgical Risk in a Rural Community

2019 ◽  
Vol 87 (4) ◽  
pp. 310-312
Author(s):  
Federico Blanco ◽  
Rodrigo Blanco ◽  
Mauricio Bonet ◽  
Gustavo Iralde ◽  
Mariano Campeni ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Rural Community ◽  
Severe Aortic Stenosis ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Asymptomatic Severe Aortic Stenosis and Noncardiac Surgery

2020 ◽  
pp. 108925322096957
Author(s):  
Stephanie K. Whitener ◽  
Loren R. Francis ◽  
Jeffrey D. McMurray ◽  
George B. Whitener
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Noncardiac Surgery ◽  
Surgical Aortic Valve Replacement ◽  
Unique Challenge ◽  
Surgical Risk ◽  
Increased Risk

The patient with severe asymptomatic aortic stenosis presenting for elective noncardiac surgery poses a unique challenge. These patients are not traditionally offered surgical aortic valve replacement or transcatheter aortic valve replacement given their lack of symptoms; however, they are at increased risk for postsurgical complications given the severity of their aortic stenosis. The decision to proceed with elective noncardiac surgery should be based on individual and surgical risk factors. However, severity of aortic stenosis is not accounted for in current surgical risk factor assessment scoring; therefore, extensive communication with patients and surgical teams is necessary to minimize a patient’s risk. A clear intraoperative plan should be designed to manage the unique hemodynamics of these patients, and a discussion should address postoperative placement.

scholarly journals A ventricular-vascular coupling model in presence of aortic stenosis

2005 ◽  
Vol 288 (4) ◽  
pp. H1874-H1884 ◽  
Author(s):  
Damien Garcia ◽  
Paul J. C. Barenbrug ◽  
Philippe Pibarot ◽  
André L. A. J. Dekker ◽  
Frederik H. van der Veen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Vascular System ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Arterial System ◽  
Coefficient Of Determination ◽  
Ventricular Afterload ◽  
Good Agreement

In patients with aortic stenosis, the left ventricular afterload is determined by the degree of valvular obstruction and the systemic arterial system. We developed an explicit mathematical model formulated with a limited number of independent parameters that describes the interaction among the left ventricle, an aortic stenosis, and the arterial system. This ventricular-valvular-vascular (V3) model consists of the combination of the time-varying elastance model for the left ventricle, the instantaneous transvalvular pressure-flow relationship for the aortic valve, and the three-element windkessel representation of the vascular system. The objective of this study was to validate the V3 model by using pressure-volume loop data obtained in six patients with severe aortic stenosis before and after aortic valve replacement. There was very good agreement between the estimated and the measured left ventricular and aortic pressure waveforms. The total relative error between estimated and measured pressures was on average (standard deviation) 7.5% (SD 2.3) and the equation of the corresponding regression line was y = 0.99 x − 2.36 with a coefficient of determination r2 = 0.98. There was also very good agreement between estimated and measured stroke volumes ( y = 1.03 x + 2.2, r2 = 0.96, SEE = 2.8 ml). Hence, this mathematical V3 model can be used to describe the hemodynamic interaction among the left ventricle, the aortic valve, and the systemic arterial system.

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