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

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

The surgical result of bioprosthetic aortic valve substitute within the Nineteen Sixties and Seventies weren't very passable. the quest for the best replacement for the diseased aortic valve led Donald Ross to enhance the idea 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 changing 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 provide unimpeded blood circulate 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 excellent valve for valve substitute isn't to be had. The- fore, surgeons are focusing their talents and their medical and s- entific wisdom on optimizing the technical artistry of val- sparing systems.

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Cribier A, Eltchaninoff H, Borenstein N (2001) Transcatheter implantation of balloon expandable prosthetic heart valves: early results in an animal model. Circulation 104:II552 (abstract) 11. Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis. Circulation 106(24): 3006–3008 12. Cribier A, Eltchaninoff H, Tron C, Bauer F, Agatiello C, Sebagh L, Bash A, Nusimovici D, Litzler PY, Bessou JP, Leon MB (2004) Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis.

At present TA-AVI offers a truly minimally invasive approach facilitating off-pump aortic valve implantation with good results even in high-risk patients with peripheral artery disease. Due to the antegrade approach minimal manipulation at the aortic arch is needed resulting in an extremely low stroke rate and the short distance from the apex to the aortic annulus allows for exact positioning of the prosthesis. In conclusion, TA-AVI is an elegant and safe option to treat high-risk patients by a transcatheter valve specialist team.

Z there is almost no limitation in the size of the delivery sheaths. In clinical practice, both options should be carefully evaluated and then selected according to the individual patient characteristics. Severe peripheral vascular disease is a clear indication for the transapical approach. TA-AVI – setup z The OR The most important difference in transcatheter AVI compared to conventional techniques is the (almost) closed chest situation not allowing for direct vision of the working field. Therefore, optimal imaging is of utmost importance to ensure precise positioning of the prosthesis – the key step in 35 36 z J.

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