scholarly journals A ministernotomia szerepe az aortabillentyű-sebészetben

2016 ◽  
Vol 157 (23) ◽  
pp. 901-904
Author(s):  
Gábor Bari ◽  
László Csepregi ◽  
Miklós Bitay ◽  
Gábor Bogáts
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Surgery ◽  
Valve Surgery ◽  
Minimal Access ◽  
Aortic Valve Surgery ◽  
Aortic Replacement ◽  
The University ◽  
Special Instrumentation

Introduction: Minimal access aortic valve replacement plays a significant role in modern cardiac surgery. The technical evolution of aortic bioprostheses, particularly sutureless valves, leads to simplify minimal access aortic valve surgery and it allows easier implantation in a narrow work field with the need of less manipulation. Aim: The aim of this study is to summarize the historical and technical aspects of minimal access aortic valve replacement, especially concentrating on sutureless valves, and to present data of own patients of the authors. Method: Pre- and post-operative data of 13 minimal access aortic replacement cases who were operated at the Deparment of Cardiac Sugery at the University of Szeged are summarized. Results and conclusions: As compared to full sternotomy, minimal access aortic surgery is safe, and it does not require special instrumentation. It is technically more demanding but it can be learned quickly, and the overall pre- and post-operative results are not worse with the benefit of less pain and superior cosmetics. Orv. Hetil., 2016, 157(23), 901–904.

Minimal-Access Aortic Valve Replacement with Concomitant Aortic Procedure: A 9-Year Experience

2012 ◽  
Vol 7 (5) ◽  
pp. 368-371 ◽  
Author(s):  
Tsuyoshi Kaneko ◽  
Gregory S. Couper ◽  
Wernard A.A. Borstlap ◽  
Foeke J.H. Nauta ◽  
Laurens Wollersheim ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Morbidity Rate ◽  
Minimal Access ◽  
True Aneurysm ◽  
Aortic Replacement

Objective Minimal-access approaches through upper hemisternotomy is an established technique for aortic valve replacement (AVR) and aortic surgery in our institution. We assessed the outcome of undergoing AVR with concomitant aortic surgery through upper hemisternotomy. Methods We retrospectively reviewed 109 patients from January 2002 to May 2011 who had AVR with concomitant aortic surgery through upper hemisternotomy. Aortic valve replacement with supra-coronary ascending aortic replacement was performed in 65 patients; AVR with ascending and proximal arch replacement, in 8 patients; AVR with aortoplasty, in 11 patients; Bentall procedure, in 8 patients; and AVR with root enlargement, in 13 patients. In-hospital outcomes and 1- and 5-year survival were examined. Results The mean age was 58.5 years (range, 23–89 years); 41.3% of patients had bicuspid aortic valve (n = 45). Of the patients, 82.6% had true aneurysm (n = 90), 2.8% had calcified aorta (n = 3), 8.3% had small annulus (n = 9), and 3.7% had calcified annulus (n = 4). There were 6 (5.5%) reoperations and 15 (13.8%) urgent cases. Mean perfusion time was 152 ± 61 minutes, and cross-clamp time was 108 ± 47 minutes. Nine cases were performed with deep hypothermic circulatory arrest (8.3%). Operative mortality was 2.8% (n = 3). There were 4 (3.7%) cases with reoperation for bleeding, 2 (1.8%) myocardial infarctions, and 2 (1.8%) new-onset renal failure. Mean length of stay was 7.1 ± 5.6 days. Kaplan-Meier analysis showed that 1-year postoperative survival was 96.2% and 5-year survival was 92.4%. Conclusions An upper hemisternotomy approach is safe and feasible for AVR and concomitant aortic surgery with good early and midterm outcomes. This approach is also associated with low morbidity rate and short length of stay.

scholarly journals Surgical Complexity and Outcome of Patients Undergoing Re-do Aortic Valve Surgery

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001209
Author(s):  
Renata Greco ◽  
Mirko Muretti ◽  
Jasmina Djordjevic ◽  
Xu Yu Jin ◽  
Elaine Hill ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Surgery ◽  
Significant Proportion ◽  
Mechanical Valve ◽  
Valve Surgery ◽  
Paravalvular Leak ◽  
Aortic Valve Surgery ◽  
Mortality And Morbidity

ObjectivesRe-do aortic valve surgery carries a higher mortality and morbidity compared with first time aortic valve replacement (AVR) and often requires concomitant complex procedures. Transcatheter aortic valve replacement (TAVR) is an option for selective patients. The aim of this study is to present our experience with re-do aortic valve procedures and give an insight into the characteristics of these patients and their outcomes.MethodsRetrospective review of 80 consecutive re-do aortic valve procedures.ResultsMean patients’ age was 51.80±18.73 years. Aortic regurgitation (AR) was present in 51 (65.4%) patients and aortic stenosis (AS) in 38 (48.7%). Indications for reoperation were: infective endocarditis (IE) (23.8%), bioprosthetic degeneration (12.5%), mechanical valve dysfunction (5%), paravalvular leak (6.2%), patient–prosthesis mismatch (3.8%), native valve disease (25%), aortic aneurysm, pseudoaneurysm and dissection (35%), aortic root/homograft degeneration (27.5%). Forty-one (51.2%) patients underwent re-do AVR, 39 (48.8%) re-do complex aortic valve surgery (28 root, 23 ascending aorta and 6 hemiarch procedures) and 37.5% concomitant procedures. A bioprosthesis was implanted in 43.8%, a mechanical valve in 37.5%, a composite graft in 2.5%, a Biovalsalva graft in 6.2% and a homograft in 10% of patients. In-hospital mortality was 3.8% and incidence of major complications was low.ConclusionsA significant proportion of patients were young (61%<60 y), required complex aortic procedures (49%) or presented with contraindications for TAVR (mechanical valve, AR, IE, proximal aortic disease, need for concomitant surgery). Re-do aortic surgery remains the only treatment for such challenging cases and can be performed with acceptable mortality and morbidity in a specialised aortic centre.

Management of a Protruding Right Coronary Artery Stent during Aortic Valve Replacement for Aortic Stenosis

2012 ◽  
Vol 7 (3) ◽  
pp. 213-216 ◽  
Author(s):  
Nnamdi Nwaejike ◽  
Christopher Rozario ◽  
Franco Sogliani
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Medical Care ◽  
Valve Replacement ◽  
Coronary Intervention ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Percutaneous Coronary

We describe the successful management of a stent protruding from the right coronary ostium into the aortic root in the setting of aortic valve replacement for aortic stenosis. Due to advances in medical care more elderly patients present for aortic valve surgery after percutaneous coronary intervention. Therefore, with an aging population due to advances in medical care, more patients will present for aortic valve surgery after percutaneous coronary intervention. We suggest a degree of caution before valve deployment in transcatheter aortic valve intervention or during annular manipulation in patients undergoing traditional aortic valve replacement with coexisting patent proximal stents.

New Trends in Aortic Valve Surgery: A critical Review of Standard Prosthesis v. Stentless Replacement and Repair

1994 ◽  
Vol 2 (2) ◽  
pp. 69-74
Author(s):  
Carlos MG Duran ◽  
Begonia Gometza ◽  
Fareed Khouqeer ◽  
Ali Al-Sanei ◽  
Zohair Al-Halees
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Mechanical Prosthesis ◽  
Actuarial Survival ◽  
Group I ◽  
Repair Group

Different alternatives for the surgical treatment of aortic valve disease have been recently introduced. All consecutive patients who underwent aortic valve surgery between July 1988 and March 1994 were reviewed. There were 674 patients with a mean age of 32.4 years, mean preoperative functional class of 2.82, and rheumatic etiology in 59% of the cases. The patients were divided into 3 groups: Group I. standard aortic valve replacement with biological and mechanical prosthesis ( n = 313); Group II. stentless aortic valve replacement using homograft, pulmonary autograft and reconstruction with pericardium ( n = 145); and Group HI. aortic valve repair ( n = 216). The hospital mortality was 6.07% for the standard, 0.68% for the stentless, and 3.70% for the repair. Total follow-up was 1,304.75 patient years with a mean of 21.93 months. The actuarial survival at 66 months excluding hospital mortality was 85.24 ± 4.59% in the standard replacement, 92.63 ± 4.03% in the stentless, and 91.20 ± 3.02% in the repair group. The highest incidence of reoperation corresponded to the repair group with an actuarial freedom from reoperation of 74.26 ±7.03%, v. 92.52 ±4.52% in the standard and 85.11 ± 6.71% in the stentless group. There were no thromboembolic events in the isolated aortic valve survivors in both the stentless and repair groups and 1.28% patient years in the standard. We conclude that both the stentless aortic valve replacement and the aortic repair represent a good alternative v. standard replacement, especially for those young rheumatic patients in which anticoagulation and durability of the prosthesis is still a problem.

scholarly journals Low-Computational Cost Stitching Method in a Three-Eyed Endoscope

2019 ◽  
Vol 2019 ◽  
pp. 1-12
Author(s):  
Virginia Mamone ◽  
Sara Condino ◽  
Fabrizio Cutolo ◽  
Izadyar Tamadon ◽  
Arianna Menciassi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Computational Cost ◽  
Valve Surgery ◽  
Definitive Treatment ◽  
Wide Field ◽  
Aortic Valve Surgery ◽  
Image Size

Aortic valve replacement is the only definitive treatment for aortic stenosis, a highly prevalent condition in elderly population. Minimally invasive surgery brought numerous benefits to this intervention, and robotics recently provided additional improvements in terms of telemanipulation, motion scaling, and smaller incisions. Difficulties in obtaining a clear and wide field of vision is a major challenge in minimally invasive aortic valve surgery: surgeon orientates with difficulty because of lack of direct view and limited spaces. This work focuses on the development of a computer vision methodology, for a three-eyed endoscopic vision system, to ease minimally invasive instrument guidance during aortic valve surgery. Specifically, it presents an efficient image stitching method to improve spatial awareness and overcome the orientation problems which arise when cameras are decentralized with respect to the main axis of the aorta and are nonparallel oriented. The proposed approach was tested for the navigation of an innovative robotic system for minimally invasive valve surgery. Based on the specific geometry of the setup and the intrinsic parameters of the three cameras, we estimate the proper plane-induced homographic transformation that merges the views of the operatory site plane into a single stitched image. To evaluate the deviation from the image correct alignment, we performed quantitative tests by stitching a chessboard pattern. The tests showed a minimum error with respect to the image size of 0.46 ± 0.15% measured at the homography distance of 40 mm and a maximum error of 6.09 ± 0.23% at the maximum offset of 10 mm. Three experienced surgeons in aortic valve replacement by mini-sternotomy and mini-thoracotomy performed experimental tests based on the comparison of navigation and orientation capabilities in a silicone aorta with and without stitched image. The tests showed that the stitched image allows for good orientation and navigation within the aorta, and furthermore, it provides more safety while releasing the valve than driving from the three separate views. The average processing time for the stitching of three views into one image is 12.6 ms, proving that the method is not computationally expensive, thus leaving space for further real-time processing.

Single-Center Outcomes with Rapid Deployment Aortic Valve Replacement

2020 ◽  
Author(s):  
Markus Schlömicher ◽  
Matthias Bechtel ◽  
Dritan Useini ◽  
Hamid Naraghi ◽  
Peter Lukas Haldenwang ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Valve Surgery ◽  
Complication Rates ◽  
Aortic Valve Surgery ◽  
All Cause Mortality ◽  
Rapid Deployment

Abstract Objectives Rapid-deployment valves can reduce procedural times and may facilitate minimally invasive surgery. In our institution, more than 500 patients underwent rapid deployment aortic valve replacement (AVR). Methods A total of 510 patients underwent rapid deployment AVR between March 2012 and September 2017, of whom 270 patients underwent isolated AVR and 240 underwent AVR with concomitant procedures. The cumulative follow-up time was 1,444 patient-years, the median follow-up time 2.8 years, respectively Results An early all-cause mortality of 3.5% (n = 18) was seen with a cumulative survival of 91.9 ± 2.2% after 12 months. Mean cross-clamp times were 37 ± 19 minutes for isolated AVR and 93 ± 29 minutes for AVR with concomitant procedures. The rate of new pacemaker implantation was 7.8% (n = 40). No case of structural degeneration occurred in the follow-up. Three (0.6%) cases of endocarditis were registered. Conclusions Rapid deployment AVR can be performed safely with low complication rates and good hemodynamic results. Therefore, the relevance in aortic valve surgery can be stressed.

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