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