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suture less aortic valve

Carl A Johnson, Amber L Melvin, Brandon F Lebow, Amanda Yap, Peter A Knight
Aortic valve replacement through minimally invasive access is increasing. These procedures have several advantages over conventional sternotomy including decreased intensive care unit and hospital length of stay and decreased ventilation time. The right anterior mini-thoracotomy (RAM) approach is potentially attractive in that it completely spares the sternum leading to improved cosmesis, reduced blood loss, and improved patient satisfaction. However, this approach is underutilized due to anticipated technical challenges including difficulty with visualization and annular suture placement...
2018: Journal of Visualized Surgery
Carl A Johnson, Katherine L Wood, Amber L Melvin, Brandon F Lebow, Peter A Knight
Aortic root replacement is typically performed through a median sternotomy. The right anterior mini-thoracotomy approach has been shown to decrease hospital length of stay in aortic valve surgery when compared to sternotomy. This approach is rare in ascending aortic surgery due to technical challenges which include exposure and annular suture placement. Automated suturing technology is now available to facilitate the placement of annular sutures. The use of a camera greatly enhances visualization of the aortic root...
2018: Journal of Visualized Surgery
Marek Jasinski
We present a modified bicuspid aortic valve reimplantation operation using a unique technique of second line, continuous suturing during implantation of the aortic valve scallop to the prosthesis that mimics stentless, minicylinder implantation.  The feasibility of bicuspid aortic valve repair with associated aortic root management has been demonstrated. However, this repair seems to be less durable than tricuspid aortic valve repair, and this may be partly because of the connective tissue disorders that are an inherent feature of bicuspid aortic valve disease...
February 12, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Ahmad Zeeshan, Jay J Idrees, Douglas R Johnston, Jeevanantham Rajeswaran, Eric E Roselli, Edward G Soltesz, A Marc Gillinov, Brian Griffin, Richard Grimm, Donald F Hammer, Gösta B Pettersson, Eugene H Blackstone, Joseph F Sabik, Lars G Svensson
BACKGROUND: To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era. METHODS: From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3...
December 11, 2017: Annals of Thoracic Surgery
Takashi Kunihara, Satoshi Arimura, Fumihiro Sata, Christian Giebels, Ulrich Schneider, Hans-Joachim Schäfers
OBJECTIVE: The lack of annular stabilization is the drawback of aortic root remodeling, and recently the addition of annuloplasty has been proposed. Limited data, however, exist on late annular size after remodeling. We studied annular size over time. METHODS: In 241 patients (53 ± 16 years) annular size was determined preoperatively (T0), before discharge (T1), and at least 2 years after remodeling (T2, 54 ± 27 months) with (n = 52) or without external suture annuloplasty...
March 2018: Journal of Thoracic and Cardiovascular Surgery
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
Bettina Langhammer, Maria Nucera, Lars Englberger, Eva Roost, David Reineke, Florian Schönhoff, Henriette Most, Bernhard Winkler, Fabian Gisler, Thierry Carrel, Christoph Huber
BACKGROUND: Surgical aortic valve replacement (SAVR) is the treatment of choice in severe symptomatic aortic valve disease. New techniques and prostheses have been recently developed to facilitate the procedure and reduce aortic cross-clamp time (AOx). The aim of this study was to analyse the different procedural steps in order to identify the most time-consuming part during aortic clamping time and to compare impact of experience on procedural aspects. METHODS: AOx during SAVR was divided into five consecutive steps...
July 11, 2017: Swiss Medical Weekly
Reza Tavakoli, Peiman Jamshidi, Max Gassmann
In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial valve might not meet the functional needs. The implantation of a too-small stented pericardial valve, leading to an effective orifice area indexed to a body surface area less than 0.85 cm(2)/m(2), is regarded as prosthesis-patient mismatch (PPM). A PPM negatively affects the regression of left ventricular hypertrophy and thus the normalization of left ventricular function and the alleviation of symptoms...
May 21, 2017: Journal of Visualized Experiments: JoVE
Robert Balan, Christian Mogilansky, Axel-Lars Larsen, Parwis Massoudy
We report the case of severe aortic regurgitation 8 months after implantation of a 25-mm sutureless pericardial aortic valve prosthesis. On echocardiography, the regurgitation was suspected to be paravalvular. The sutureless prosthesis had been implanted using an automatic knot fastener device, which renders the suture tails less pliable because of the metal clip that is crimped around the suture. The patient was reoperated, a paravalvular leak was not observed. The sutureless prosthesis was explanted and a conventional biologic valve prosthesis was implanted instead...
July 1, 2017: Interactive Cardiovascular and Thoracic Surgery
Julinda Mehilli, David Jochheim, Mohamed Abdel-Wahab, Konstantinos D Rizas, Hans Theiss, Nina Spenkuch, Magda Zadrozny, Moritz Baquet, Mohamed El-Mawardy, Takao Sato, Philipp Lange, Christian Kuppatt, Martin Greif, Jörg Hausleiter, Axel Bauer, Florian Schwarz, Maximilian Pichlmaier, Christian Hagl, Gert Richardt, Steffen Massberg
AIMS: In the current study we assess the impact of two different access-site suture-mediated closure devices (SMCD), ProGlide and Prostar, on vascular and bleeding complications after transfemoral transcatheter aortic valve implantation (TAVI), as well as on long-term mortality. METHODS AND RESULTS: From 2008 to 2013, 1,022 patients underwent transfemoral TAVI in two German centres using ProGlide (n=506) and Prostar (n=516) SMCD to close the access site. The primary outcome was the incidence of peri-TAVI major vascular complications according to Valve Academic Research Consortium-2 (VARC-2) definitions...
November 20, 2016: EuroIntervention
Paolo Berretta, Marco Di Eusanio
Aortic valve stenosis is the most common valve disease in the western world. Over the past few years the number of aortic valve replacement (AVR) interventions has increased with outcomes that have been improved despite increasing age of patients and increasing burden of comorbidities. However, despite such excellent results and its well-established position, conventional AVR has undergone great development over the previous two decades. Such progress, by way of less invasive incisions and use of new technologies, including transcatheter aortic valve implantation and sutureless valve prostheses, is intended to reduce the traumatic impact of the surgical procedure, thus fulfilling lower risk patients' expectations on the one hand, and extending the operability toward increasingly high-risk patients on the other...
September 2016: Journal of Geriatric Cardiology: JGC
Candice Y Lee, Joshua K Wong, Ronald E Ross, David C Liu, Kamal R Khabbaz, Angelo J Martellaro, Heather R Gorea, Jude S Sauer, Peter A Knight
OBJECTIVE: Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). METHODS: Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Nawsad Saleh, Rodney De Palma, Magnus Settergren, Andreas Rück
OBJECTIVES: To evaluate the efficacy and safety of a double Prostar XL suture-based closure technique compared to a conventional single Prostar XL technique in elective transcatheter aortic valve implantation (TAVI) via the common femoral artery. BACKGROUND: TAVI is recommended as a treatment for symptomatic severe aortic stenosis for those who are at high or prohibitive risk of surgical valve replacement. Vascular complications remain the most frequent category of procedural complication...
December 1, 2015: Catheterization and Cardiovascular Interventions
Marco Di Eusanio, Francesco Saia, Giovanni Pellicciari, Kevin Phan, Marinella Ferlito, Gianni Dall'Ara, Roberto Di Bartolomeo, Antonio Marzocchi
Sutureless aortic valve implantation has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to improve surgical outcomes by facilitating less traumatic minimally invasive approaches and reducing cross-clamp and cardiopulmonary bypass duration. However, the absence of sutures may have detrimental effects after sutureless interventions, including paravalvular leakages, valve dislocation, and stent-infolding. Transcatheter aortic valve-in-valve implantation (A-ViV) is emerging as a valuable procedure in patients with dysfunctioning biological aortic valves who are deemed inoperable with conventional surgery...
March 2015: Annals of Cardiothoracic Surgery
Domenico Mazzitelli, Christof Stamm, J Scott Rankin, Steffen Pfeiffer, Theodor Fischlein, Jan Pirk, Yeong-Hoon Choi, Christian Detter, Johannes Kroll, Friedhelm Beyersdorf, Malakh Shrestha, Christian Schreiber, Rüdiger Lange
BACKGROUND: Refining leaflet reconstruction has become a primary issue in aortic valve repair. This descriptive analysis reviews leaflet pathology, repair techniques, and early results in a prospective regulatory trial of aortic valve repair. METHODS: Sixty-five patients underwent valve repair for predominant moderate to severe aortic insufficiency (AI). The mean age was 63 ± 13 years, and 69% of the patients were male. Ascending aortic/root replacement was required in 62%...
December 2014: Annals of Thoracic Surgery
Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Yukinari Nozawa, Mikio Takatoh, So Hagiwara, Nagaki Kiyohara
OBJECTIVE: We have performed an original aortic valve reconstruction using autologous pericardium. The feasibility for patients aged less than 60 years is reviewed. METHODS: From April 2007 to April 2013, aortic valve reconstruction was performed in 108 patients aged less than 60 years. A total of 51 patients had aortic stenosis, 7 patients had annuloaortic ectasia, 7 patients had infective endocarditis, and 43 patients had aortic regurgitation. Fifty-seven patients had bicuspid valves, and 11 patients had unicuspid valves...
September 2014: Journal of Thoracic and Cardiovascular Surgery
Gideon Praveen Kumar, Fangsen Cui, Hui Qun Phang, Boyang Su, Hwa Liang Leo, Jimmy Kim Fatt Hon
Percutaneous heart valve replacement is gaining popularity, as more positive reports of satisfactory early clinical experiences are published. However this technique is mostly used for the replacement of pulmonary and aortic valves and less often for the repair and replacement of atrioventricular valves mainly due to their anatomical complexity. While the challenges posed by the complexity of the mitral annulus anatomy cannot be mitigated, it is possible to design mitral stents that could offer good anchorage and support to the valve prosthesis...
July 2014: Medical Engineering & Physics
Clifton T P Lewis, Richard L Stephens, Charles M Tyndal, Jennifer L Cline
BACKGROUND: Robotic mitral valve repair has been successfully performed since the late 1990s, but concomitant robotic tricuspid repair has not yet been widely adopted. We report our first 5 years' experience with concomitant robotic mitral-tricuspid valve repair. METHODS: Records were reviewed for all patients who underwent concomitant robotic mitral-tricuspid valve repair in a single practice. Cardiopulmonary bypass was performed with femoral cannulation, antegrade and retrograde cardioplegia, and aortic cross-clamping by balloon occlusion...
March 2014: Annals of Thoracic Surgery
Gregory A Fishbein, Frederick J Schoen, Michael C Fishbein
Calcific aortic valve disease of the elderly is the most prevalent hemodynamically-significant valvular disease, and the most common lesion requiring valve replacement in industrialized countries. Transcatheter aortic valve implantation is a less invasive alternative to classical aortic valve replacement that can provide a therapeutic option for high-risk or inoperable patients with aortic stenosis. These devices must be biocompatible, have excellent hemodynamic performance, be easy to insert, be securely anchored without sutures, and be durable, without increased risk of thrombosis or infection...
March 2014: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Giovanni Concistrè, Giuseppe Santarpino, Steffen Pfeiffer, Pierandrea Farneti, Antonio Miceli, Francesca Chiaramonti, Marco Solinas, Mattia Glauber, Theodor Fischlein
OBJECTIVE: Important comorbid conditions in patients referred for aortic valve replacement (AVR) require less invasive strategies. We describe our initial experience with the Perceval S (Sorin Group, Saluggia, Italy) and 3f Enable (Medtronic, Minneapolis, MN USA) sutureless aortic bioprostheses. METHODS: We compared intraoperative data, postoperative clinical outcomes, and echocardiographic results from patients receiving a Perceval S (P group; n = 97) or a 3f Enable (E group; n = 32) prosthesis in two cardiac surgery departments (Nuremberg, Germany, and Massa, Italy)...
July 2013: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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