Aortic Root Surgery: The Biological Solution

3798518688......Page 1
Title page......Page 3
Copyright  Page   \r......Page 4
Preface......Page 6
Table of Contents......Page 9
Authors......Page 16
I Imaging of the aortic root......Page 21
History......Page 22
Why iTEE before cardiopulmonary bypass?......Page 23
iTEE in patients undergoing mitral valve surgery......Page 24
iTEE evaluation during transapical aortic valve replacement......Page 26
References......Page 29
II Innovations in\raortic valve surgery......Page 30
The anatomic units of the aortic root......Page 31
The aortic annulus......Page 35
The aortic sinuses of Valsalva......Page 36
The coronary arteries......Page 37
References......Page 38
History of percutaneous aortic valve replacement......Page 40
Device description and procedure......Page 41
Outcomes following implantation......Page 46
References......Page 48
The concept of transcatheter aortic valve impIantation......Page 50
Transcatheter aortic valve prostheses......Page 51
Anatomical considerations......Page 52
The OR......Page 53
The “safety net”......Page 54
Positioning of the fluoroscopic system......Page 55
Valvuloplasty and valve deployment......Page 56
How to achieve optimal outcome......Page 59
Postoperative care......Page 60
Current results......Page 61
References......Page 62
Introduction......Page 64
Techniques of minimally invasive aortic valve surgery......Page 65
Results after minimally invasive aortic valve surgery......Page 66
Percutaneous aortic valve replacement......Page 68
Results after percutaneous aortic valve replacement......Page 70
Conclusions......Page 71
References......Page 72
Introduction......Page 75
Operative technique......Page 76
Comments......Page 79
References......Page 80
III The Ross operation:\rAortic valve and root\rreplacement with\rpulmonary autograft\r......Page 82
Pulmonary autograft or aortic allograft for surgical treatment of active infective aortic valve endocarditis: a review of the literature\r......Page 83
The pulmonary autograft in the aortic position......Page 84
Aortic root replacement......Page 85
Comments......Page 86
References......Page 88
The Ross operation: two decades of clinical experience\r......Page 90
The German-Dutch Ross registry......Page 92
Results......Page 94
Discussion......Page 97
Conclusions......Page 99
References......Page 100
IV Aortic valve repair\rand valve sparing\rroot procedures\r......Page 102
Etiology......Page 103
Diagnosis......Page 104
Classification......Page 105
Valve-related complications......Page 108
Aortic complications......Page 111
References......Page 112
Descriptive anatomy......Page 116
The aortic valve apparatus: a dynamic structure......Page 118
Echocardiographic anatomy of the normal aortic root......Page 120
Composite valve and graft replacement......Page 121
Aortic valve-sparing procedures......Page 122
In vivo studies......Page 123
Repair of cusp prolapse and bicuspid valve......Page 134
Conservative aortic valve surgery versus valve replacement: what do we know?\r......Page 136
References......Page 140
Techniques of valve-sparing aortic root replacement......Page 147
Methods......Page 148
Results......Page 149
Discussion......Page 152
References......Page 156
The normal aortic annulus and root......Page 158
Aging......Page 163
“Annuloaortic ectasia”/Marfan syndrome......Page 164
Bicuspid aortic valve......Page 165
Geometric mismatch without annuloplasty......Page 166
Reduction aortic annuloplasty......Page 168
Suturing techniques......Page 169
Subcommissural plication......Page 170
Intertrigonal plication......Page 171
Circumferential plication......Page 172
Resection......Page 175
Augmentation annuloplasty......Page 176
Aortic-mitral curtain enlargement procedures......Page 177
Ventricular septum enlargement procedures (aortoventriculoplasty)......Page 180
References......Page 184
Pathophysiological considerations......Page 192
Surgical technique......Page 193
Patients......Page 195
Comments......Page 196
References......Page 198
Balancing potential benefits with risks......Page 199
Technical aspects of using BioGlue during aortic root repair......Page 201
References......Page 203
V Endocarditis......Page 206
Introduction......Page 207
Appendix 1......Page 208
Conceptual challenges......Page 209
Timing......Page 210
Special populations......Page 211
Anatomical and technical issues......Page 213
Risk stratification......Page 215
References......Page 216
Introduction......Page 222
Patient population......Page 223
The Shelhigh® SuperStentless bioprosthesis......Page 225
Statistical analysis......Page 226
Overall survival and survival in relation to surgical urgency......Page 227
Survival in relation to abscess formation......Page 228
Reinfection after Shelhigh® implantation......Page 229
Survival and surgical urgency......Page 230
Clinical results of Shelhigh® bioprostheses......Page 231
References......Page 232
Introduction......Page 235
Prosthetic endocarditis......Page 236
Simple and destructive forms of endocarditis......Page 237
Paravalvular abscess as the main sign of the destructive form of endocarditis\r......Page 238
Echocardiographic definition of abscess......Page 239
Extension of infection from the aortic area......Page 241
Double valve disease......Page 242
Asymptomatic destruction of the heart structures after successful medical treatment of AIE\r......Page 243
Primary mitral valve endocarditis......Page 244
Three-dimensional echocardiography......Page 245
Conclusions......Page 248
References......Page 249
Introduction......Page 255
Methods......Page 256
Pre- and postoperative monitoring and diagnostics......Page 259
Surgical techniques......Page 261
Lower (proximal) suture line.......Page 263
Freehand subcoronary aortic valve replacement......Page 264
Statistical methods......Page 266
Hospital mortality......Page 267
Late mortality......Page 268
Early and late complications......Page 269
Discussion......Page 275
Recommendations for cardiologists, surgeons, and patients......Page 280
References......Page 281
Surgical management of aortic root abscess......Page 286
Pericardial reconstruction of the left ventricular outflow tract......Page 287
Aortic root replacement and reimplantation of the coronary arteries......Page 290
Freehand subcoronary aortic valve replacement......Page 292
Comments......Page 294
References......Page 298
VI Surgery\rfor atrial fibrillation\r......Page 300
Surgical treatment options......Page 301
Surgical technique and perioperative management......Page 304
Results – perioperative......Page 306
Long-term results......Page 307
Comment......Page 308
References......Page 310
Minimally invasive endoscopic ablation on the beating heart in patients with lone atrial fibrillation......Page 312
Current surgical ablation practice......Page 313
Totally endoscopic ablation......Page 314
Surgical procedure......Page 316
Ablation......Page 317
Follow-up......Page 319
References......Page 320
VII Hemodynamic\revaluation\rof the bioprosthetic\raortic valves\r......Page 321
The common approach to bioprosthetic valve evaluation......Page 322
Effective orifice area......Page 323
Patient-prosthesis mismatch and effective orifice area index......Page 325
Geometric orifice area – a valid alternative......Page 327
Materials and methods......Page 328
Geometric orifice areas......Page 332
Space efficiency......Page 336
An additional observation – leaflet flutter......Page 339
Discussion......Page 341
Study limitations......Page 344
References......Page 345
VIII Long-term results\rof biological valves\r......Page 347
Clinical data – patients......Page 348
Follow-up......Page 349
Statistical analysis......Page 350
Survival......Page 351
Late adverse events (Table 3)......Page 352
Late New York Heart Association functional classification.......Page 353
Discussion......Page 354
References......Page 356
Introduction: stentless biological valves......Page 358
Subcoronary technique......Page 359
Total root technique......Page 360
Valve prosthesis-patient mismatch......Page 361
Technical issues of subcoronary technique and the impact of the surgeons on hemodynamic outcome\r......Page 362
Subcoronary versus total root implantation technique *......Page 367
The Freestyle® bioprosthesis: valve related morbidity and mortality *\r......Page 370
Concomitant replacement of the ascending aorta......Page 372
Octogenarians......Page 373
References......Page 374
Introduction......Page 378
Material and methods......Page 379
Operative technique Freedom......Page 380
Operative technique Solo......Page 381
Results......Page 384
Discussion......Page 386
References......Page 387
Stented and stentless aortic bioprostheses: competitive or complimentary?\r......Page 389
References......Page 392
Introduction......Page 394
Transvalvular flow dynamics......Page 396
In vitro hemodynamic performance......Page 397
In vitro durability tests......Page 399
Clinical flow dynamics and aortic root preservation......Page 401
Summary......Page 402
References......Page 403
Patients......Page 404
Operative technique......Page 405
Late mortality......Page 406
Nonstructural dysfunction.......Page 407
Structural valve deterioration.......Page 408
Hemodynamic data......Page 409
Comment......Page 410
Conclusion......Page 412
References......Page 413
Introduction......Page 414
Echocardiography......Page 415
Surgical technique......Page 416
Results......Page 417
Discussion......Page 420
References......Page 422
Patients......Page 424
Follow-up......Page 425
Patient survival......Page 426
Valve-related death......Page 427
Reoperation......Page 428
Structural valve deterioration......Page 429
Discussion......Page 430
References......Page 433
20-Year durability of bioprostheses in the aortic position......Page 435
References......Page 441
The BioValsalva conduit......Page 442
Operative technique......Page 444
Inhospital outcomes......Page 446
Discussion......Page 449
References......Page 451
Clinical results including hemodynamic performance of the Medtronic Mosaic porcine bioprosthesis up to ten years *......Page 453
Patient population and study design......Page 454
Statistical analysis......Page 456
Echocadiography......Page 457
Cardiac rhythm......Page 458
Adverse events......Page 459
Thrombosed valves......Page 461
Bleeding......Page 462
Explants......Page 463
Mortality......Page 464
Discussion......Page 465
Conclusion......Page 467
References......Page 468
Introduction......Page 470
Methods......Page 471
Preoperative imaging......Page 474
Statistical analysis......Page 475
Valve re-replacement with mechanical prosthesis after bioprosthetic structural valve deterioration\r......Page 476
Hospital mortality by period: 1986–2007.......Page 477
Long-term survival......Page 478
Comments......Page 479
Conclusions......Page 483
References......Page 484
Background......Page 487
Patients and methods......Page 488
Design and characteristics of the Mitroflow pericardial bioprosthesis......Page 490
Surgical procedure......Page 491
Follow-up......Page 492
Postoperative anticoagulation......Page 494
Long-term survival......Page 496
Postoperative hemodynamic profile......Page 498
Structural valve deterioration......Page 499
Nonstructural valve deterioration......Page 502
Hemorrhage......Page 503
Discussion......Page 504
References......Page 507
Follow-up......Page 511
Statistical analysis......Page 512
Patient survival......Page 513
Structural valve deterioration......Page 514
Thromboembolism......Page 515
Survival......Page 516
Structural valve deterioration......Page 517
Other complications......Page 518
Conclusion......Page 519
References......Page 520
Valve replacement in renal dialysis patients: bioprostheses versus mechanical prostheses......Page 522
References......Page 526
IX Predictors\rof patient’s outcome\r......Page 527
Study patients......Page 528
Statistics......Page 529
Results......Page 530
Discussion......Page 532
Conclusion......Page 533
References......Page 534
Determinants of survival after AVR......Page 535
Predicted patient outcome after AVR......Page 537
Stentless bioprostheses......Page 538
Allografts......Page 539
Predicted patient outcome after the Ross operation in young adults......Page 540
Summary and conclusions......Page 541
References......Page 542
X Anticoagulation\r......Page 544
Anticoagulation and general complications......Page 545
Patient autonomy......Page 546
Self-management......Page 547
Telemedical monitoring......Page 548
Low-dose anticoagulation......Page 549
References......Page 552
XI Tissue engineering\r......Page 553
Heart valve tissue engineering......Page 554
Decellularization process......Page 555
Polymer coating......Page 556
Toxicity and cell proliferation......Page 557
Mechanical tissue properties......Page 558
Leaflet testing......Page 559
Valve testing......Page 560
In vivo biocompatibility testing......Page 561
Large animal testing......Page 562
Interpretation......Page 563
References......Page 564
Background......Page 567
Biological scaffolds......Page 568
Synthetic scaffolds......Page 569
Cell sources......Page 570
Cell seeding and in vitro conditioning......Page 571
Conclusion and perspectives......Page 573
References......Page 574
Tissue engineering with a decellularized valve matrix......Page 577
References......Page 581
XII Regularatory issues\ron tissue valves\r......Page 582
United States......Page 583
European Union......Page 585
Decellularized cardiac tissues......Page 587
References......Page 588
Concluding remarks......Page 590
Conclusion......Page 591
Acknowledgments......Page 592
Atlas of biological valves......Page 593
Subject index......Page 601