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Minimally invasive heart valve replacement

Andy C Kiser, Thomas G Caranasos, Mark D Peterson, David M Holzhey, Philipp Kiefer, L Wiley Nifong, Michael A Borger
OBJECTIVE: Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access...
February 17, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Christopher Young, Günther Laufer, Alfred Kocher, Marco Solinas, Francesco Alamanni, Gianluca Polvani, Bruno K Podesser, Jose Ignacio Aramendi, Jose Arribas, Olivier Bouchot, Ugolino Livi, Massimo Massetti, Kim Terp, Christophe Giot, Mattia Glauber
OBJECTIVE: The goals of rapid-deployment aortic valve replacement include facilitation of minimally invasive surgery and reduced aortic crossclamp time. We report the short-term outcomes of a series of 493 patients undergoing rapid-deployment aortic valve replacement with the EDWARDS INTUITY valve system (Edwards Lifesciences, LLC, Irvine, Calif). METHODS: Assessing Standard oF Care and Clinical Outcomes UsiNg the EDWARDS INTUITY VAlve SysTem in a European multI-center, Active, pOst-market surveillaNce Study was a prospective, multicenter (n = 26) European registry designed to evaluate the safety and performance of the valve system...
February 2018: Journal of Thoracic and Cardiovascular Surgery
Torsten Doenst, Mahmoud Diab, Christoph Sponholz, Michael Bauer, Gloria Färber
BACKGROUND: Over the past two decades, minimally invasive techniques for classic heart valve surgery and isolated bypass surgery have been developed that enable access to the heart via partial sternotomy for most aortic valve procedures and via sternotomy-free mini-thoracotomy for other procedures. METHODS: We review the current evidence on minimally invasive cardiac surgery on the basis of pertinent randomized studies and database studies retrieved by a selective search in the MEDLINE and PubMed Central databases, as well as by the Google Scholar search engine...
November 17, 2017: Deutsches Ärzteblatt International
Rachel M Easterwood, Ian C Bostock, Shruthi Nammalwar, Jock N McCullough, Alexander Iribarne
The field of minimally invasive cardiac surgery has undergone rapid transformation over recent years. In this review, we provide a summary of the most current evidence supporting the use of minimally invasive aortic and mitral valve replacement techniques, as well as transcatheter approaches for aortic and mitral valve disease. As an adjunct, the use of robotically assisted coronary bypass surgery and hybrid coronary revascularization procedures is discussed. In order to obtain optimal patient outcomes, a collaborative, heart-team approach between cardiac surgeons and interventional cardiologists is necessary...
January 2018: Future Cardiology
Gianluca Rigatelli, Fabio Dell'Avvocata, Luca Conte, Daniela Lanza, Sara Giatti, Pierluigi Del Santo, Loris Roncon, Giuseppe Faggian
BACKGROUND: Balloon Aortic valvuloplasty (BAV) is considered as a bridge therapy to percutaneous valve implantation or a palliative treatment in patients with aortic valve stenosis (AVS). Potential risk of complications, in particular in fragile patients, is still not negligible. AIM: To describe the technique and outcomes of modified BAV in fragile symptomatic patients unsuitable for other treatments using no-pacing and minimally invasive approach. METHODS: Symptomatic fragile patients with severe aortic valve stenosis judged unsuitable by the heart team for surgical or percutaneous valve implantation from 1 September 2013 to 1 September 2017 were offered modified BAV...
October 19, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Joshua K Wong, Amber L Melvin, Juan A Siordia, Devang J Joshi, Jude S Sauer, Peter A Knight
PURPOSE: Annular suture placement during minimally invasive right anterior thoracotomy aortic valve replacements (MI-AVR) can be challenging. We present the early clinical experience with novel automated suturing technology that may reduce the technical difficulty of this operation. DESCRIPTION: The technology presented involves an automated articulating suturing device that simultaneously drives dual-curved needles through the aortic annulus to place a pledgeted horizontal mattress suture remotely; a second device with 2 straight needles places suture through the sewing cuff of a prosthetic heart valve...
February 2018: Annals of Thoracic Surgery
Toshinori Totsugawa, Arudo Hiraoka, Kentaro Tamura, Hidenori Yoshitaka, Taichi Sakaguchi
Here, we demonstrate bilateral pulmonary vein isolation using a bipolar clamp but without atriotomy during minimally invasive aortic valve replacement. The operation was performed through a right anterolateral minithoracotomy. The right pulmonary veins were ablated by using a radiofrequency clamp on the beating heart. After cardiac arrest, the ascending aorta was pulled up using umbilical tape passed through the transverse sinus. Appendage resection offered fine exposure around the lower pulmonary vein. The bipolar clamp was introduced into the oblique sinus under the aorta, and the left pulmonary veins were ablated...
December 2017: Annals of Thoracic Surgery
Nathaniel W Taggart, Allison K Cabalka, Andreas Eicken, Jamil A Aboulhosn, John D R Thomson, Brian Whisenant, Martin L Bocks, Stephan Schubert, Thomas K Jones, Jeremy D Asnes, Thomas E Fagan, Jeffery Meadows, Mark Hoyer, Mary H Martin, Frank F Ing, Daniel R Turner, Azeem Latib, Aphrodite Tzifa, Stephan Windecker, Bryan H Goldstein, Jeffrey W Delaney, James A Kuo, Susan Foerster, Matthew Gillespie, Gianfranco Butera, Shabana Shahanavaz, Eric Horlick, Younes Boudjemline, Daniel Dvir, Doff B McElhinney
We sought to describe the acute results and short- to medium-term durability of transcatheter tricuspid valve-in-valve (TVIV) implantation within surgical bioprostheses among patients with Ebstein anomaly (EA). Cases were identified from a voluntary, multicenter, international registry of 29 institutions that perform TVIV. Demographic, clinical, procedural, and follow-up data were analyzed. Eighty-one patients with EA underwent TVIV from 2008 to 2016. Thirty-four patients (42%) were New York Heart Association (NYHA) class 3/4 at time of TVIV...
January 15, 2018: American Journal of Cardiology
Milind Y Desai, Francesco Grigioni, Marco Di Eusanio, Matteo Saccocci, Maurizio Taramasso, Francesco Maisano, Rakesh M Suri, A Marc Gillinov
Mitral regurgitation (MR) is the one of the most frequent valvular heart diseases in the developed world, often requiring surgical correction. Degenerative MR is the most common type of non-ischemic, organic MR in the western world. Since no medical treatment has been shown to be effective in preventing the consequences of volume overload in asymptomatic degenerative MR, risk stratification is essential. Currently, this is achieved using clinical and precisely quantified echocardiographic parameters, with newer technologies like cardiac magnetic resonance gaining increasing prominence...
November 9, 2017: Progress in Cardiovascular Diseases
Sameer A Hirji, Fernando Ramirez-Del Val, Ahmed A Kolkailah, Julius I Ejiofor, Siobhan McGurk, Ritam Chowdhury, Jiyae Lee, Pinak B Shah, Piotr S Sobieszczyk, Sary F Aranki, Marc P Pelletier, Prem S Shekar, Tsuyoshi Kaneko
BACKGROUND: Contemporary options for aortic valve replacement (AVR) include transcatheter and surgical approaches (TAVR and SAVR). As evidence accrues for TAVR in high and intermediate risk patients, some clinicians advocate that all patients aged over 80 years should only receive TAVR. Our aim was to investigate the utility of SAVR and minimally invasive AVR (mAVR) among octogenarians in the current era of TAVR. METHODS: From 2002 to 2015, 1,028 octogenarians underwent isolated AVR; 306 TAVR and 722 SAVR, of which 378 patients underwent mAVR...
September 2017: Annals of Cardiothoracic Surgery
M A Karaskov, Y I Zhuravleva, V A Bogachev-Prokophiev, P D Demidov
Mitral valve disease is highly prevalent and quickly leads to development of severe heart failure. Mitral valve disease of degenerative or ischemic etiology affects 7.5 and 9.3% of population older than 65 and 75 years, respectively. "Open" (with cardiopulmonary bypass) surgical repair or valve replacement are not possible in almost half of affected patients because of their complications and concomitant diseases responsible for extremely high risk of these interventions. In the last decade, minimally invasive endovascular technology - transcatheter aortic valve implantation (TAVI) - has been widely introduced for correction of aortic valve disease in similar category of patients...
August 2017: Kardiologiia
Marco Piciche, Guglielmo Actis Dato, Roberto Lorusso, Francesco Musumeci
INTRODUCTION: Aortic valve surgery is no exception to the general rule that history is a cycle in many fields. This manuscript aims to assist readers in transitioning from past to present and on into the future within the field of aortic valve surgery. METHODS: The existing literature has been examined, including old and modern articles published on pubmed, old articles non visible on pubmed, old and recent books on the history of medicine, looking for similarities and repetitions in techniques and surgical approaches to the aortic valve in the past and the current times...
October 9, 2017: Reviews on Recent Clinical Trials
Anthony Nguyen, Louis-Mathieu Stevens, Denis Bouchard, Philippe Demers, Louis P Perrault, Michel Carrier
Rapid-deployment valves could potentially reduce cross-clamping time and cardiopulmonary bypass time in complex combined procedures and facilitate minimally invasive surgery. This propensity-matched study compared clinical and echographic outcomes between patients undergoing rapid-deployment aortic valve replacement (RDAVR) compared with stented biological aortic valve replacement (SAVR), with or without concomitant procedures. Between 2012 and 2015, 61 consecutive patients (age 70 ± 7 years, European System for Cardiac Operative Risk Evaluation [EuroSCORE] II 2...
September 8, 2017: Seminars in Thoracic and Cardiovascular Surgery
Corazon M Calle-Valda, Rio Aguilar, Amparo Benedicto, Anas Sarraj, Emilio Monguio, Daniel Munoz, Nieves De Antonio, Guillermo Reyes
BACKGROUND: Previous trials have shown that, among high-risk patients with aortic stenosis, survival rates are similar for transcatheter aortic-valve implantation (TAVI) and surgical aortic valve replacement. The study aimed to compare the outcomes of aortic valve replacement according to the adopted surgical approach in intermediate and low risk patients. METHODS: This is a retrospective, observational, cohort study of prospectively collected data from 421 patients undergoing isolated aortic valve replacement between 2011 and 2015...
September 6, 2017: Heart, Lung & Circulation
Orlando Santana, Steve Xydas, Roy F Williams, Angelo LaPietra, Maurice Mawad, Frederick Hasty, Esteban Escolar, Christos G Mihos
BACKGROUND: Double valve surgery is associated with an increased peri-operative morbidity and mortality. A less invasive right thoracotomy approach may be a viable alternative to median sternotomy surgery in these higher-risk patients. METHODS: We retrospectively analyzed the baseline demographics, operative characteristics, and post-operative outcomes of patients who underwent minimally invasive double valve surgery between January 2009 and December 2011 at our institution...
June 2017: Journal of Thoracic Disease
Junyu Zhai, Lai Wei, Ben Huang, Chunsheng Wang, Hongqiang Zhang, Kanhua Yin
The aim of the study was to evaluate the treatment of minimally invasive mitral valve replacement (MIMVR) through a right minithoracotomy for patients with rheumatic mitral valve disease.From February 2009 to December 2016, 360 patients with rheumatic mitral valve disease underwent mitral valve replacement by the same surgeon. Among them, 150 patients accepted MIMVR through a right minithoracotomy, whereas the other 210 accepted a traditional median sternotomy. After matching by patients by age, sex, EuroSCORE, New York Heart Association (NYHA) classification, renal and liver function, and degree of mitral valve disease, we selected 224 patients for analysis in our retrospective study...
June 2017: Medicine (Baltimore)
Sukhdeep Basra, Molly Szerlip
Valvular heart diseases such as aortic stenosis and mitral regurgitation are often associated with heart failure, which in turn increases patients' Surgical Thoracic Society (STS) score. A high STS score means the patient is high risk for surgical aortic valve replacement and mitral valve repair/replacement. Transcatheter aortic valve replacement and percutaneous mitral valve repair offer a minimally invasive alternative for the treatment of valvular heart disease in patients with severe heart failure. We aim to review the current evidence on the safety, efficacy, and outcomes of these devices in patients with severe heart failure...
July 2017: Interventional Cardiology Clinics
Karan Sian, Sheila Li, Daneish Selvakumar, Ross Mejia
BACKGROUND: Minimally invasive aortic valve replacement (MAVR) has demonstrated a benefit with respect to increased patient satisfaction due to minimised pain and earlier recovery. Sutureless valves may benefit MAVR and conventional aortic valve replacement (AVR) by reducing operative times and blood transfusion requirements. The Perceval valve (Sorin, Salluggia, Italy) is a self-expanding prosthesis made from bovine pericardium mounted in a nitinol stent, designed to simplify the implantation of an aortic valve...
March 2017: Journal of Thoracic Disease
Andrew K Capulli, Maximillian Y Emmert, Francesco S Pasqualini, Debora Kehl, Etem Caliskan, Johan U Lind, Sean P Sheehy, Sung Jin Park, Seungkuk Ahn, Benedikt Weber, Josue A Goss, Simon P Hoerstrup, Kevin Kit Parker
Tissue engineered scaffolds have emerged as a promising solution for heart valve replacement because of their potential for regeneration. However, traditional heart valve tissue engineering has relied on resource-intensive, cell-based manufacturing, which increases cost and hinders clinical translation. To overcome these limitations, in situ tissue engineering approaches aim to develop scaffold materials and manufacturing processes that elicit endogenous tissue remodeling and repair. Yet despite recent advances in synthetic materials manufacturing, there remains a lack of cell-free, automated approaches for rapidly producing biomimetic heart valve scaffolds...
July 2017: Biomaterials
Stuart J Head, Mevlüt Çelik, A Pieter Kappetein
Mechanical valves used for aortic valve replacement (AVR) continue to be associated with bleeding risks because of anticoagulation therapy, while bioprosthetic valves are at risk of structural valve deterioration requiring reoperation. This risk/benefit ratio of mechanical and bioprosthetic valves has led American and European guidelines on valvular heart disease to be consistent in recommending the use of mechanical prostheses in patients younger than 60 years of age. Despite these recommendations, the use of bioprosthetic valves has significantly increased over the last decades in all age groups...
July 21, 2017: European Heart Journal
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