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。