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Minimally invasive heart valve replacement

Emanuela S Fioretta, Petra E Dijkman, Maximilian Y Emmert, Simon P Hoerstrup
Heart valve replacement is often the only solution for patients suffering from valvular heart disease. However, currently available valve replacements require either life-long anti-coagulation or are associated with valve degeneration and calcification. Moreover, they are suboptimal for young patients, because they do not adapt to the somatic growth. Tissue-engineering has been proposed as a promising approach to fulfill the urgent need for heart valve replacements with regenerative and growth capacity. This review will start with an overview on the currently available valve substitutes and the techniques for heart valve replacement...
September 30, 2016: Journal of Tissue Engineering and Regenerative Medicine
Peyman Sardari Nia, Samuel Heuts, Jean Daemen, Peter Luyten, Jindrich Vainer, Jan Hoorntje, Emile Cheriex, Jos Maessen
OBJECTIVES: Mitral valve repair performed by an experienced surgeon is superior to mitral valve replacement for degenerative mitral valve disease; however, many surgeons are still deterred from adapting this procedure because of a steep learning curve. Simulation-based training and planning could improve the surgical performance and reduce the learning curve. The aim of this study was to develop a patient-specific simulation for mitral valve repair and provide a proof of concept of personalized medicine in a patient prospectively planned for mitral valve surgery...
September 27, 2016: Interactive Cardiovascular and Thoracic Surgery
Trust Saidi, Tania S Douglas
The treatment of rheumatic heart disease presents a medical and surgical challenge, particularly in developing countries, where the disease is prevalent. Most of these countries find it prohibitively expensive to import heart valve prostheses that are required for treatment and are largely manufactured in the United States and Europe. Even if the valves were available, the absence of facilities to conduct open-heart surgery for valve replacement results in many people from developing countries dying needlessly of the disease...
October 2016: Expert Review of Medical Devices
Matthew Moore, Glenn R Barnhart, Walter Randolph Chitwood, John A Rizzo, Candace Gunnarsson, Swetha R Palli, Eugene A Grossi
OBJECTIVE: The recent development of the EDWARDS INTUITY Elite™ (EIE) valve system enables the rapid deployment of a prosthetic surgical heart valve in an aortic valve replacement (AVR) procedure via both the minimally invasive (MISAVR) and conventional (CAVR) approaches. In order to understand its economic value, this study performed a cost evaluation of the EIE valve system used in a MIS rapid-deployment approach (MIS-RDAVR) vs MISAVR and CAVR, respectively, compared to standard prosthetic aortic valves...
October 2016: Journal of Medical Economics
Enrico Ferrari, Olivier Muller, Stefanos Demertzis, Marco Moccetti, Tiziano Moccetti, Giovanni Pedrazzini, Eric Eeckhout
Transaortic transcatheter aortic valve replacement performed through a right anterolateral minithoracotomy at the second intercostal space is a safe and standardized minimally invasive procedure carrying important clinical advantages for the patient, in particular, no damage to the ventricular apex, preservation of the diseased peripheral arteries and no cross of the aortic arch with the delivery system, meaning a lower risk of calcium dislodgement and neurological complications. Using the third-generation, balloon-expandable Edwards Sapien™ 3 transcatheter heart valve and the Certitude™ delivery system, the transaortic procedure is easily performed under fluoroscopic and echocardiographic guidance...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Muhammet Onur Hanedan, İlker Mataracı, Mehmet Ali Yürük, Tanıl Özer, Ufuk Sayar, Ali Kemal Arslan, Uğur Ziyrek, Murat Yücel
BACKGROUND: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation...
June 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Reto Basciani, Felix Kröninger, Erich Gygax, Hansjörg Jenni, David Reineke, Monika Stucki, Niels Hagenbuch, Thierry Carrel, Balthasar Eberle, Gabor Erdoes
To compare intraoperative cerebral microembolic load between minimally invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC) during isolated surgical aortic valve replacement (SAVR), we conducted a randomized trial in patients undergoing primary elective SAVR at a tertiary referral hospital. The primary outcome was the procedural phase-related rate of high-intensity transient signals (HITS) on transcranial Doppler ultrasound. HITS rate was used as a surrogate of cerebral microembolism in pre-defined procedural phases in SAVR using MiECC or CECC with (+F) or without (-F) an oxygenator with integrated arterial filter...
June 10, 2016: Artificial Organs
Michele Murzi, Alfredo Giuseppe Cerillo, Danyar Gilmanov, Giovanni Concistrè, Pierandrea Farneti, Mattia Glauber, Marco Solinas
OBJECTIVE: The study objective was to assess the learning process and quality of care of right minithoracotomy aortic valve replacement with a sutureless bioprosthesis at a single institution. METHODS: We performed an analysis of the first 300 consecutive patients (aged 76 ± 6 years; logistic European System for Cardiac Operative Risk Evaluation 9 ± 6) who underwent sutureless valve implantation via a right minithoracotomy by 6 surgeons at the G. Pasquinucci Heart Hospital between 2011 and 2015...
May 10, 2016: Journal of Thoracic and Cardiovascular Surgery
Frederick J Schoen, Avrum I Gotlieb
The past several decades have witnessed major advances in the understanding of the structure, function, and biology of native valves and the pathobiology and clinical management of valvular heart disease. These improvements have enabled earlier and more precise diagnosis, assessment of the proper timing of surgical and interventional procedures, improved prosthetic and biologic valve replacements and repairs, recognition of postoperative complications and their management, and the introduction of minimally invasive approaches that have enabled definitive and durable treatment for patients who were previously considered inoperable...
July 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Andreas A Giannopoulos, Michael L Steigner, Elizabeth George, Maria Barile, Andetta R Hunsaker, Frank J Rybicki, Dimitris Mitsouras
Medical 3-dimensional (3D) printing is emerging as a clinically relevant imaging tool in directing preoperative and intraoperative planning in many surgical specialties and will therefore likely lead to interdisciplinary collaboration between engineers, radiologists, and surgeons. Data from standard imaging modalities such as computed tomography, magnetic resonance imaging, echocardiography, and rotational angiography can be used to fabricate life-sized models of human anatomy and pathology, as well as patient-specific implants and surgical guides...
September 2016: Journal of Thoracic Imaging
Feroze Mahmood, Stanton Keith Shernan
Transoesophageal echocardiography (TOE) is used in the perioperative arena to monitor patients during life-threatening emergencies, cardiac and high-risk non-cardiac surgeries. It provides qualitative and quantitative information on valvular and ventricular functions, and dynamic cardiac anatomy can be displayed with a physiological perspective. This technology has evolved from two-dimensional (2D) to the ready availability of real-time three-dimensional (RT-3D) imaging in the operating rooms. Enhanced spatial and temporal resolutions with 3D imaging have most significantly impacted the quality of intraoperative surgical valve repair and replacement decisions...
August 1, 2016: Heart: Official Journal of the British Cardiac Society
Basel Ramlawi, Walid K Abu Saleh, Odeaa Al Jabbari, Colin M Barker, Neal S Kleiman, Michael J Reardon
Transcatheter aortic valve replacement is becoming a routine procedure to treat severe symptomatic aortic stenosis. At most transcatheter aortic valve replacement centers, transapical access is a frequent alternative for use in patients whose ileofemoral access is inadequate. Transapical access is increasingly applied to a variety of other structural heart and aortic procedures as well. There is a caveat, however. When performed in elderly patients with friable myocardium, transapical access is associated with such serious sequelae as bleeding and left ventricular apical pseudoaneurysmal formation...
February 2016: Texas Heart Institute Journal
Peter Wenaweser, Fabien Praz, Stefan Stortecky
Aortic stenosis is the most common valvular heart disease in Western industrial countries (including Switzerland) with a prevalence of about 5% in the population aged 75 and over. If left untreated, symptomatic patients have a rate of death of more than 50% within 2 years. As a result of age and elevated surgical risk, an important proportion of elderly patients are not referred to surgery. Thus, the introduction of transcatheter aortic valve implantation (TAVI) in 2002 has initiated a paradigm shift in the treatment of patients with symptomatic, severe aortic stenosis...
2016: Swiss Medical Weekly
Torsten P Vahl, Rebecca T Hahn, Jeffrey W Moses
No abstract text is available yet for this article.
April 19, 2016: Circulation
Samaneh Ghazanfari, Anita Driessen-Mol, Simon P Hoerstrup, Frank P T Baaijens, Carlijn V C Bouten
The use of valved stents for minimally invasive replacement of semilunar heart valves is expected to change the extracellular matrix and mechanical function of the native artery and may thus impair long-term functionality of the implant. Here we investigate the impact of the stent on matrix remodeling of the pulmonary artery in a sheep model, focusing on matrix composition and collagen (re)orientation of the host tissue. Ovine native pulmonary arteries were harvested 8 (n = 2), 16 (n = 4) and 24 (n = 2) weeks after transapical implantation of self-expandable stented heart valves...
2016: Cells, Tissues, Organs
Amjad Shalabi, Ehud Raanani, Amihai Shinfeld, Rafael Kuperstein, Alexander Kogan, Alexander Lipey, Eyal Nachum, Dan Spiegelstein
UNLABELLED: Background: Prolonged life expectancy has increased the number of elderly high risk patients referred for surgical aortic valve replacement (AVR). These referred high risk patients may benefit from sutureless bioprosthesis procedures which reduce mortality and morbidity. OBJECTIVES: To present our initial experience with sutureless aortic bioprotheses, including clinical and echocardiographic results, in elderly high risk patients referred for AVR. METHODS: Forty patients (15 males, mean age 78 ± 7 years) with symptomatic severe aortic stenosis underwent AVR with the 3F Enable or Perceval sutureless bioprosthesis during the period December 2012 to May 2014...
February 2016: Israel Medical Association Journal: IMAJ
Theodor Fischlein, Bart Meuris, Kavous Hakim-Meibodi, Martin Misfeld, Thierry Carrel, Marian Zembala, Sara Gaggianesi, Francesco Madonna, François Laborde, Federico Asch, Axel Haverich
OBJECTIVE: Sutureless aortic valve replacement (AVR) offers an alternative to standard AVR in aortic stenosis. This prospective, single-arm study aimed to demonstrate safety and effectiveness of a bovine pericardial sutureless aortic valve at 1 year. METHODS: From February 2010 to September 2013, 658 patients (mean age 78.3 ± 5.6 years; 40.0% octogenarian; 64.4% female; mean Society of Thoracic Surgeons score 7.2 ± 7.4) underwent sutureless AVR in 25 European centers...
June 2016: Journal of Thoracic and Cardiovascular Surgery
Shio Priye, J Sathyanarayan, S Shivaprakash, Durgaprasad Reddy
Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of stenotic mitral valve with Bombay phenotype who underwent minimal invasive right lateral thoracotomy for the replacement of the mitral valve. A male patient from Bangladesh presented to the hospital with New York Heart Association III symptoms. His medical evaluation revealed severe mitral valve stenosis and mild aortic valve regurgitation. The patient received erythropoietin, intravenous iron succinate and folic acid tablets...
December 2015: Indian Journal of Anaesthesia
Augusto D'Onofrio, Gino Gerosa
The development of new techniques for the treatment of almost all structural heart pathologies that do not require cardiopulmonary bypass and aortic cross-clamping, such as transcatheter aortic valve replacement and transapical mitral chordae implantation, define a new age of our specialty: the micro-invasive (microICS) cardiac surgery era.
September 2015: Journal of Heart Valve Disease
Mark Young Lee, Srinath Chilakamarri Yeshwant, Sreedivya Chava, Daniel Lawrence Lustgarten
Transcatheter aortic valve replacement (TAVR) has emerged as a valuable, minimally invasive treatment option in patients with symptomatic severe aortic stenosis at prohibitive or increased risk for conventional surgical replacement. Consequently, patients undergoing TAVR are prone to peri-procedural complications including cardiac conduction disturbances, which is the focus of this review. Atrioventricular conduction disturbances and arrhythmias before, during or after TAVR remain a matter of concern for this high-risk group of patients, as they have important consequences on hospital duration, short- and long-term medical management and finally on decisions of device-based treatment strategies (pacemaker or defibrillator implantation)...
August 2015: Arrhythmia & Electrophysiology Review
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