Aortic Root Surgery: The Biological Solution

ISBN-13: 9783798518681 / Angielski / Twarda / 2009 / 616 str.

Abraham Charles Yankah; Yu-Guo Weng; Roland Hetzer

Opis

The surgical results of bioprosthetic aortic valve replacement in the 1960s and 1970s were not very satisfactory. The search for the ideal substitute for the diseased aortic valve led Donald Ross to develop the concept of the aortic allograft in 1962 and the pulmonary autograft in 1967 for subcoronary implantation, and later, in 1972, as a full root for replacing the aortic root in the infected aortic valve with a root abscess. The aortic al- graft and pulmonary autograft surgical procedures were revo- tionary in the history of cardiac valve surgery in the last m- lennium because they compete well with the bioprosthesis, are nonthrombogenic (thus, requiring no postoperative anticoa- lation), are resistant to infection, restore the anatomic units of the aortic or pulmonary outflow tract, and offer unimpeded blood flow and excellent hemodynamics, giving patients a b- ter prognosis and quality of life. Surgery for congenital, degenerative, and inflammatory aortic valve and root diseases has now reached a high level of maturity; yet an ideal valve for valve replacement is not available. The- fore, surgeons are focusing their skills and their clinical and s- entific knowledge on optimizing the technical artistry of val- sparing procedures.

Spis treści

Imaging of the aortic root.- Perioperative imaging for assessing aortic and mitral valve diseases and surgical procedures.- Innovations in aortic valve surgery.- The aortic root.- Percutaneous transluminal aortic valve replacement: The CoreValve prosthesis.- Transapical aortic valve implantation — A truly minimally invasive option for high-risk patients.- From minimally invasive to percutaneous aortic valve replacement.- Sutureless equine aortic valve replacement.- The Ross operation: Aortic valve and root replacement with pulmonary autograft.- Pulmonary autograft or aortic allograft for surgical treatment of active infective aortic valve endocarditis: a review of the literature.- The Ross operation: two decades of clinical experience.- Aortic valve repair and valve sparing root procedures.- The bicuspid aortic valve.- From dynamic anatomy to conservative aortic valve surgery: the tale of the ring.- Yacoub/David techniques for aortic root operation: success and failures.- Aortic annuloplasty.- Correction of aortic valve incompetence combined with ascending aortic aneurysm by relocation of the aortic valve plane through a short-length aortic graft replacement.- Using BioGlue to achieve hemostasis in aortic root surgery.- Endocarditis.- Challenges in the surgical management of infective endocarditis.- Clinical results of the Shelhigh® stentless bioprosthesis in patients with active infective endocarditis:.- Double valve endocarditis and evolving paraannular abscess formation.- Aortic root abscess: reconstruction of the left ventricular outflow tract and allograft aortic valve and root replacement.- Implantation techniques of freehand subcoronary aortic valve and root replacement with a cryopreserved allograft for aortic root abscess.- Surgery for atrial fibrillation.- Cryoablation for the treatment of atrial fibrillation in patients undergoing minimally invasive mitral valve surgery.- Minimally invasive endoscopic ablation on the beating heart in patients with lone atrial fibrillation.- Hemodynamic evaluation of the bioprosthetic aortic valves.- Evaluation of bioprosthetic valve performance as a function of geometric orifice area and space efficiency— A reliable alternative to effective orifice area.- Long-term results of biological valves.- Stented and stentless aortic bioprostheses: competitive or complimentary?.- Edwards Prima Plus Stentless Bioprosthesis: Long-term clinical and hemodynamic results.- The Cryo-Life O’Brien stentless valve: 1991–2008.- Medtronic stentless Freestyle® porcine aortic valve replacement.- The ATS 3f Aortic Bioprosthesis.- The Vascutek Elan stentless porcine prosthesis — The Glasgow experience.- Sorin pericardial valves.- The changing role of pericardial tissue in biological valve surgery: 22 years’ experience with the Sorin Mitroflow stented pericardial valve.- 20 years’ durability of Carpentier-Edwards Perimount stented pericardial aortic valve.- Twenty-year experience with the St. Jude Medical Biocor bioprosthesis in the aortic position.- 20-Year durability of bioprostheses in the aortic position.- Clinical results including hemodynamic performance of the Medtronic Mosaic porcine bioprosthesis up to ten years.- Aortic root replacement with the BioValsalva prosthesis.- Valve replacement in renal dialysis patients: bioprostheses versus mechanical prostheses.- Replacement of bioprostheses after structural valve deterioration.- Predictors of patient’s outcome.- Predicted outcomes after aortic valve replacement in octogenarians with aortic stenosis.- Predicted patient outcome after bioprosthetic AVR and the Ross operation.- Anticoagulation.- Anticoagulation and self-management of INR: mid-term results.- Tissue engineering.- Biomatrix-polymer hybrid material for heart valve tissue engineering.- Standards for the in vitro fabrication of heart valves using human umbilical cord cells.- Tissue engineering with a decellularized valve matrix.- Regularatory issues on tissue valves.- Human tissues for cardiovascular surgery: regulatory requirements.- Concluding remarks.- Concluding remarks.- Atlas of biological valves.- Atlas of biological valves.

Blurb

The surgical treatment of the aortic valve and root disease, organic and ischemic mitral regurgitation, and endocarditis has made great strides. Still, there is the well-known dilemma: on the one hand the need for anticoagulation in patients with mechanical valves that otherwise guarantee long-term functioning and, on the other, the unpredictable durability of biological substitutes and of valve repair procedures which, per se, do not require anticoagulation. The choice of procedure is determined by factors such as patients' age, metabolic and bleeding disorders, and bleeding preconditions, as well as such critical issues as the desire to bear children in young women.

The book contains a collection of proceedings of The Berlin Heart Valve Symposium which was held in November 2008. It focuses on current surgical approaches to and evolving trends in aortic valve repair, aortic root and valve replacement with pulmonary autograft, aortic allograft, stentless and stented bioprostheses.  Further contributions will deal with recent advances in catheter-based percutaneous and transapical techniques, ablation techniques for atrial fibrillation, tissue engineering of heart valves, multi-modality imaging, and anticoagulation.