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Michael J Mack - One of the best experts on this subject based on the ideXlab platform.
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transapical aortic valve Implantation step by step
The Annals of Thoracic Surgery, 2009Co-Authors: Thomas Walther, Todd M Dewey, Michael A Borger, Jorg Kempfert, Axel Linke, Reinhardt Becht, Volkmar Falk, Gerhard Schuler, Friedrich W Mohr, Michael J MackAbstract:Purpose Transapical aortic valve Implantation is a new minimally invasive technique for beating heart, off-pump, aortic valve Implantation in high-risk patients. Description The procedure involves antegrade aortic valve Implantation using an oversizing technique with direct access and accurate positioning of a stent-based transcatheter xenograft. Procedural steps include placement of femoral arterial and venous access wires, anterolateral mini-thoracotomy, epicardial pacing, and apical pursestring suture placement. Valve positioning is performed under fluoroscopic and echocardiographic guidance during rapid ventricular pacing. Evaluation Patient screening, especially regarding native aortic annulus diameter and pattern of calcification, is essential for success. Since imaging is crucial, Implantations are optimally performed in a hybrid operative theater by an experienced team of cardiac surgeons, cardiologists, and anesthetists. Conclusions The aim of this article is to outline the technical aspects of the new technique of minimally invasive transapical aortic valve Implantation.
Ronald G Carere - One of the best experts on this subject based on the ideXlab platform.
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transcatheter valve in valve Implantation for failed bioprosthetic heart valves
Circulation, 2010Co-Authors: John G Webb, David A Wood, Ronen Gurvitch, Jeanbernard Masson, Josep Rodescabau, Mark Osten, Eric Horlick, Olaf Wendler, Eric Dumont, Ronald G CarereAbstract:Background— The majority of prosthetic heart valves currently implanted are tissue valves that can be expected to degenerate with time and eventually fail. Repeat cardiac surgery to replace these valves is associated with significant morbidity and mortality. Transcatheter heart valve Implantation within a failed bioprosthesis, a “valve-in-valve” procedure, may offer a less invasive alternative. Methods and Results— Valve-in-valve Implantations were performed in 24 high-risk patients. Failed valves were aortic (n=10), mitral (n=7), pulmonary (n=6), or tricuspid (n=1) bioprostheses. Implantation was successful with immediate restoration of satisfactory valve function in all but 1 patient. No patient had more than mild regurgitation after Implantation. No patients died during the procedure. Thirty-day mortality was 4.2%. Mortality was related primarily to learning-curve issues early in this high-risk experience. At baseline, 88% of patients were in New York Heart Association functional class III or IV; at th...
Rudiger Lange - One of the best experts on this subject based on the ideXlab platform.
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predictors for new onset complete heart block after transcatheter aortic valve Implantation
Jacc-cardiovascular Interventions, 2010Co-Authors: Sabine Bleiziffer, Hendrik Ruge, Jurgen Horer, A Hutter, Sarah Geisbusch, Gernot Brockmann, Domenico Mazzitelli, Robert Bauernschmitt, Rudiger LangeAbstract:Objectives The aim of this study was to identify risk factors for new-onset atrioventricular (AV) block requiring pacemaker (PM) Implantation after transcatheter aortic valve Implantation (TAVI). Background High-grade AV block and consecutive PM Implantation are frequent complications following TAVI. Methods For logistic regression analysis, we included 159 patients (mean age: 81 ± 6 years, EuroSCORE: 22 ± 13%) who underwent TAVI (n = 116 transfemoral, n = 4 via subclavian artery, n = 37 transapical, n = 2 transaortic) between June 2007 and January 2009 and who had no previously implanted PM. Results Thirty-five patients (22%) developed new-onset post-operative AV block with the need of PM Implantation. Logistic regression revealed a 2-fold increased risk for new-onset AV block in patients in whom a large valve is implanted in a small annulus (32% pacemaker Implantations, odds ratio [OR]: 2.378, p = NS), a 4-fold increased risk with the Implantation of the CoreValve (Medtronic, Minneapolis, Minnesota) versus the Edwards Sapien valve (Edwards Lifesciences, Irvine, California) (27% pacemaker Implantations, OR: 3.781, p = NS), and a 5-fold increased risk for patients who exhibit an AV block episode instantly during the Implantation procedure (49% pacemaker Implantations, OR: 4.819, p = 0.001). Pre-existing ECG alterations were not identified as risk factors for AV block after transcatheter aortic valve Implantation. Conclusions We assume that conduction tissue impairment is provoked by mechanical compression with large prostheses in smaller annuli or in the larger area of the CoreValve covering the outflow tract and may appear instantly during the Implantation procedure. Continuous post-operative electrocardiogram monitoring should be performed for at least 3 days in all patients after TAVI procedures and until discharge in patients with increased risk for this complication.
Sven Martens - One of the best experts on this subject based on the ideXlab platform.
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extracorporeal membrane oxygenation as perioperative right ventricular support in patients with biventricular failure undergoing left ventricular assist device Implantation
European Journal of Cardio-Thoracic Surgery, 2011Co-Authors: M Scherer, A S Sirat, A Moritz, Sven MartensAbstract:Objective: Left-ventricular assist device (LVAD) Implantation complicated by early right ventricle (RV) failure has a poor prognosis. This study details our center’s experience with veno-arterial extracorporeal membrane oxygenation (ECMO) as perioperative RV support in patients with preoperative biventricular failure undergoing LVAD Implantation. Methods: Ten patients, who underwent LVAD Implantation, were retrospectively analyzed. Six patients were already supported with ECMO before LVAD Implantation. In four patients, the ECMO was implanted before weaning from cardiopulmonary bypass. Results: All patients showed reduced RV function with elevated right-ventricular end-diastolic diameter (RVEDD) (38 4 mm) and RV systolic pressure (48 14 mmHg). The mean pulmonary artery pressure (PAP) was 36 9 mmHg. Nine patients showed dilatation of the tricuspid annulus (35 mm) with moderate tricuspid valve insufficiency and received tricuspid valve annuloplasty. After removal of the ECMO, none of the patients developed RV failure. ECMO was removed 4 1 days after LVAD Implantation. Four patients expired while on LVAD support due to not-device-related sepsis (two patients), mesenteric ischemia (one patient), and gastrointestinal bleeding (one patient), respectively. Overall survival was 60%. Conclusion: ECMO provided a satisfactory perioperative right-heart support in patients with preoperative biventricular failure undergoing LVAD Implantations, who otherwise were better candidates for biventricular assist device. ECMO allowed time for the already compromised right ventricle to get attuned to the increasing preload, and avoids distension and RV failure. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Thomas Walther - One of the best experts on this subject based on the ideXlab platform.
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transapical aortic valve Implantation step by step
The Annals of Thoracic Surgery, 2009Co-Authors: Thomas Walther, Todd M Dewey, Michael A Borger, Jorg Kempfert, Axel Linke, Reinhardt Becht, Volkmar Falk, Gerhard Schuler, Friedrich W Mohr, Michael J MackAbstract:Purpose Transapical aortic valve Implantation is a new minimally invasive technique for beating heart, off-pump, aortic valve Implantation in high-risk patients. Description The procedure involves antegrade aortic valve Implantation using an oversizing technique with direct access and accurate positioning of a stent-based transcatheter xenograft. Procedural steps include placement of femoral arterial and venous access wires, anterolateral mini-thoracotomy, epicardial pacing, and apical pursestring suture placement. Valve positioning is performed under fluoroscopic and echocardiographic guidance during rapid ventricular pacing. Evaluation Patient screening, especially regarding native aortic annulus diameter and pattern of calcification, is essential for success. Since imaging is crucial, Implantations are optimally performed in a hybrid operative theater by an experienced team of cardiac surgeons, cardiologists, and anesthetists. Conclusions The aim of this article is to outline the technical aspects of the new technique of minimally invasive transapical aortic valve Implantation.