The Future of Aortic Stenosis: Sternotomy, Minimally Invasive, or TAVR?

The Future of Aortic Stenosis: Sternotomy, Minimally Invasive, or TAVR?

https://www.youtube.com/watch?v=ZRilu5WOxgA&list=PLC9uVfWun4-QcEPD2CJKbW4imsaZ9LLYz&index=4

Many options
Gold standard is AVR through stenotomy!
Trials of TAVI will show the answers,
So far, TAVI mortality 1%, stroke less than 1%!!!

大動脈弁逆流制御における弁輪縫縮の役割 小宮先生

第３回九州心臓弁膜症カンファレンス
日本ライフライン社提供DVD

大動脈弁逆流制御における弁輪縫縮の役割　小宮先生
Annulus 20-24mm
外側からシェファーズ・スティッチ

Apical Edwards SAPIEN 3 Transcatheter Mitral Valve Replacement

Apical Edwards SAPIEN 3 Transcatheter Mitral Valve Replacement
Tuesday, August 9, 2016
By
Ilir Hysi
Olivier Fabre

https://www.youtube.com/watch?v=dULr6GMh_hk&list=PLC9uVfWun4-QcEPD2CJKbW4imsaZ9LLYz&index=5
http://www.ctsnet.org/article/apical-edwards-sapien-3-transcatheter-mitral-valve-replacement

81F
MVR Mosaic 27 in 2009
Severe MR
Transapical, Mitral!!!, Valve in valve

New stentress valve SOLO SMART

New stentress valve SOLO SMART

Japan Lifeline社提供　DVD
ステントレス生体弁SOLO SMARTの使用経験
宮崎病院　金城先生

86F　AS+ Asc Ao dilatation

Operator head camera

1, Valve resection
2, Stay sutures for commissure x3, 4-0 prolene?
3, Valve sizing
4, Marking commissures with violete pen
5, Stay sutures for nadias
6, Cuff sutures x6 tie
7, Nadia-commissure suture (x8?x6) like reimplantation
8, Valve holder remove

Very similar to Ozaki method

Rarely Seen Surgical Footage of Carcinoid Heart Disease By Piedmont's Marcus Heart Valve Center Featuring Federico Milla

Rarely Seen Surgical Footage of Carcinoid Heart Disease
By Piedmont's Marcus Heart Valve Center Featuring Federico Milla

https://www.vumedi.com/video/rarely-seen-surgical-footage-of-carcinoid-heart-disease/



66F Carcinoid syndrome
Severe TR & Severe PR
PVR + RV outflow reconstruction + TVR
on-pump beating

Clampless Technique in Open Revascularization of Acute Mesenteric Ischemia

Clampless Technique in Open Revascularization of Acute Mesenteric Ischemia


http://www.ctsnet.org/article/clampless-technique-open-revascularization-acute-mesenteric-ischemia?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=Pulse+9%2F13%2F16


The PAS-Port Proximal Anastomotic System (Cardica Inc., Redwood City, CA) creates sutureless proximal aortic anastomoses without the need for cross-clamping, although its use elsewhere in the body has not been reported.

Proximal anastomosis: abdominal aorta below diaphragm above liver

ASのエコー診断

ASエコー　
Real ASの診断が大切　測定誤差の可能性も考慮しないといけない。
poor LV function : classical 昔から知られているAS末期の状態: low outputのために大動脈弁が広がらない。ドブタミン負荷でわかる
preserved LV function: paradoxical : LV小さい
動脈硬化で後負荷が増加。CI減少。よくわかっていない。中等度AS、Hefpefも入っていると考えられている。心筋疾患？ドブタミン負荷、運動負荷でもわからない。
最近は弁口面積より圧較差を重視している。

Debate Topic: 65-year-old Male with Severe Bi-Leaflet Prolapse: Midline Approach vs. Mini-Thoracotomy

By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Hugo Vanermen, Patrick McCarthy

https://www.vumedi.com/video/debate-topic-65-year-old-male-with-severe-bi-leaflet-prolapse-midline-approach-vs-mini-thoracotomy/?utm_campaign=Top+5+Trials+in+Peripheral+Vascular+Disease&utm_term=Surgery+-+Cardiac&utm_content=Debate+Topic%3A+65-year-old+Male+with+Severe+Bi-Leaflet+Prolapse%3A+Midline+Approach+vs.+Mini-Thoracotomy+&utm_source=USER+cardiac+%26+thoracic+surgery_13536&mail_id=13536&utm_medium=Video&token=0526aafa-7395-4333-84be-2f4cc492ec29

Approach: Team, Safety, Comfotable for surgeon, MAC

Posterior Middle Segment Prolapse Repair - Triangular Resection

Posterior Middle Segment Prolapse Repair - Triangular Resection
By Mitral Foundation Featuring David Adams, Javier Castillo, Percy Boateng

https://www.vumedi.com/video/posterior-middle-segment-prolapse-repair-triangular-resection/

1. Annular suture
2. P2 resection
3. Valve suture continuous 5-0 x2
4. Ring
5. Test ink

Mitraclip case

Challenging Case Direct Myocardial Revascularization
By Scottsdale Interventional Forum 2015 Featuring Saibal Kar

https://www.vumedi.com/video/challenging-cases-dmr/

Mitraclip case?

85yo Male　Post CABG　NYHA3
eccentric MR PISA1.1 EVOA0.42
severe MAC  no MS
Bi leaflet prolapse

Mitraclip x2 (medial side)

Robotic Mitral Valve Surgery: Current Status and a Look into the Future

Robotic Mitral Valve Surgery: Current Status and a Look into the Future
By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Rakesh Suri

https://www.vumedi.com/video/robotic-mitral-valve-surgery-current-status-and-a-look-into-the-future/

Echocardiography was improved
Mitral physiology
500 pts long term f/u
Team, Learning-curve

Valve selection for AVR

Edwards社提供　2015年胸部外科学会　ランチョンセミナー　2015/10/18
Tirone David
Valve selection for AVR

No interactions with valve type
Age, LV function, CAD, preoperative NYHA, co-mobilities affect survival
Durability of tissue valve highly depend on pt's age
TAVI: comparative mortality (AVR)

Cabrol Technique for Composite Replacement of the Aortic Valve and Ascending Aorta

Cabrol Technique for Composite Replacement of the Aortic Valve and Ascending Aorta

https://www.vumedi.com/video/redo-aortic-surgery-the-cabrol-technique/


47 yo man
tyoe A dissection repair 13 years ago
heart failure

Severe AR + pseudoaneurysm 7.2cm of Asc Ao.

Cabrol technique: 8mm Dacron graft + 5-0 prolene
1, RCA end to end
2, LCA end to end
3, Proximal anast
4, Distal anast
5, side to side of grafts

Good
no need mobilization of coronary button
Bad
patency

What is the Risk of Adding Aortic Replacement to Cardiac Surgery?

What is the Risk of Adding Aortic Replacement to Cardiac Surgery?
By Cleveland Clinic Heart and Vascular Institute

https://www.vumedi.com/video/what-is-the-risk-of-adding-aortic-replacement-to-cardiac-surgery/


Matched pair study might lead misunderstandings because there were no high risk patients.

Asc Ao did not add risk to cardiac surgery.
Circulatory arrest add risk? No!
The unmatched patietns ' orange'

Minimally Invasive Aortic Valve Replacement via Anterolateral Thoracotomy

https://www.youtube.com/watch?v=AjdL0JagAKI

right thracotomy no thracoscope 7cm skin insion
Venous cannulation (right atrium) from another skin incision site (thoracotomy)
Arterial cannulation was inserted through asc. aorta by using of with a 19 F uncoated ECMO cannula
No groin cannulations
Sutureless valve (Edwards intuity) : just three suture at commisures

Good
Central cannulation, no groin cannulations
Less bleeding and infection
Cosmetic

Bad
Postoperative pain?
Sacrifice of RIMA
Difficult technique

Questuion
need differential lung ventilation?

Ischemic MR By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Robert Dion

Ischemic MR By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Robert Dion

  https://www.vumedi.com/video/ischemic-mr/?utm_campaign=Endovascular+Revascularization+of+Left+Renal+Artery+Live+Case&utm_term=Mitral+Valve+Surgery&utm_content=Ischemic+MR+&utm_source=USERS+cardiac+surgery_13586&mail_id=13586&utm_medium=Video&token=d462012e-c84d-418e-8420-2fc430106105



Ischemic MR : Controvetial Because LV function is not so good

LVED 65: magic number
Less than 65: Annuloplasty OK
Over 65: need additional procedure (Relocation or suspention of posterior PM, PM approximation, augumantation of P2-3)
Try repair (not recommend replacement)

  http://webcast.aats.org/2013/files/Saturday/20130504_balla_1330_14.20%20Robert%20A.%20Dion.pdf