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 hunt for the suitable alternative 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 a whole 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 heritage 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 proof against an infection, restoration the anatomic devices of the aortic or pulmonary outflow tract, and supply unimpeded blood circulate and ideal hemodynamics, giving sufferers a b- ter analysis and caliber of existence. surgical procedure for congenital, degenerative, and inflammatory aortic valve and root illnesses has now reached a excessive point of adulthood; but an incredible 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 approaches.
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Additional info for Aortic Root Surgery: The Biological Solution
Brown ML, Pellikka PA, Schaff HV, Scott CG, Mullany CJ, Sundt TM, Dearani JA, Daly RC, Orszulak TA (2008) The benefits of early valve replacement in asymptomatic patients with severe aortic stenosis. J Thorac Cardiovasc Surg 135:308– 315 3. Huber CH, Goeber V, Berdat P, Carrel T, Eckstein F (2007) Benefits of cardiac surgery in octogenarians – a postoperative quality of life assessment. Eur J Cardiothorac Surg 31:1099–1105 4. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Silvay G, Adams DH (2008) Excellent early and late outcomes of aortic valve replacement in people aged 80 and older.
The SAPIENTM valve mimics the design of a conventional bioprosthesis and has Fig. 1. Edwards SAPIENTM transcatheter heart valve 33 34 z J. Kempfert et al. to be implanted in a strictly subcoronary position. 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).
Given a relatively new complex procedure aiming at very high-risk patients, complications will occur sooner or later. Therefore the whole team should be prepared to take appropriate action immediately, if required. Typical events are as follows: z Hemodynamic deterioration after RVP or during valve positioning: consider early CPB support if inotropes are not sufficient. 41 42 z J. Kempfert et al. z Apical tear or bleeding: consider additional pledget reinforced Ustitches. In case of major bleeding use CPB to unload the left ventricle.