Download Aortic Root Surgery: The Biological Solution by Charles Abraham Yankah, Yu-Guo Weng, Roland Hetzer PDF

By Charles Abraham Yankah, Yu-Guo Weng, Roland Hetzer

The surgical result of bioprosthetic aortic valve alternative within the Sixties and Seventies weren't very passable. the quest for the appropriate alternative for the diseased aortic valve led Donald Ross to boost the concept that of the aortic allograft in 1962 and the pulmonary autograft in 1967 for subcoronary implantation, and later, in 1972, as an entire root for exchanging the aortic root within the contaminated aortic valve with a root abscess. The aortic al- graft and pulmonary autograft surgeries have been revo- tionary within the historical past of cardiac valve surgical procedure within the final m- lennium simply because they compete good with the bioprosthesis, are nonthrombogenic (thus, requiring no postoperative anticoa- lation), are immune to an infection, restoration the anatomic devices of the aortic or pulmonary outflow tract, and supply unimpeded blood movement and perfect hemodynamics, giving sufferers a b- ter diagnosis and caliber of lifestyles. surgical procedure for congenital, degenerative, and inflammatory aortic valve and root illnesses has now reached a excessive point of adulthood; but an amazing valve for valve substitute isn't to be had. The- fore, surgeons are focusing their abilities and their scientific and s- entific wisdom on optimizing the technical artistry of val- sparing tactics.

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The valve within a steel stent is anchored within the aortic annulus by active ballooning of the valve stent. The SAPIENTM system is at present the only commercially available device for transapical aortic valve implantation (TA-AVI) but can also be deployed using the retrograde transfemoral approach (TF-AVI). Patient selection z Risk assessment According to the literature, advanced age alone is not sufficient to deem a patient at high-risk for AVR [4]. Today several different scoring systems are used for risk assessment.

2. Cardiac-CT demonstrating the diameter of the aortic annulus and the distance of the left coronary ostia to the aortic annulus sured counts). In addition to TEE, a cardiac CT (Fig. 2) is of help to measure the distance between the coronary ostia and the level of the aortic annulus and thus provides an impression of where to position the prosthesis. z Transapical or transfemoral AVI? To date, there is no scientific evidence proving the superiority of one of these approaches. The transfemoral (TF-AVI) access allows for a completely closed chest procedure without the need for intubation.

Comments Currently, the aortic root is an area of innovative surgery. The recent development of transapical and percutaneous sutureless aortic valve replacement is an example of history repeating itself. The first clinical rapid sutureless fixation of a mechanical valve in the aortic position was introduced by Magovern and Cromie in 1962 [17, 18]. There are two first-generation transcatheter biological aortic valve replacements, the Edwards Sapien and the CoreValve for transapical and transfemoral approaches, being used in multiple centers in Europe, while two other devices, the Sadra Lotus and the Direct Flow Medical, are undergoing safety and efficacy testing [8–12, 19].

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