1,721,071 research outputs found
Sutureless and rapid deployment valves: Implantation technique from A to Z-the perceval valve
Full text linkIn the last two decades, sutureless (Perceval, Livallova PLC, London, UK) and rapid deployment valves (RD) (Intuity, Edwards Lifesciences, Irvine, CA, USA) were introduced to the market as an innovative alternative to traditional valves for patients requiring an aortic valve replacement (AVR). These devices have been studied extensively and in use across the last fifteen years. They have proven to not only demonstrate comparable results with conventional sutured biological valves-particularly helpful in minimally invasive cardiac surgery-but also provide an almost curative treatment to patients with intermediate-to-high surgical risk, filling the gap between transcatheter aortic valve implantation (TAVI) and traditional AVR. However, both sutureless and RD valves require special steps for implantation, resulting in a learning curve. Specific training for all surgical team members is mandatory, as recommended by the manufacturers. The aim of this review article is therefore to provide cardiac surgeons with a thorough guide on the implantation technique for each of these two prosthetic devices, from A to Z. In this first article, we will start by focusing on Perceval
Sutureless and rapid deployment valves: implantation technique from A to Z-the INTUITY Elite valve
Full text linkIn the last two decades, sutureless (Perceval, Livanova PLC, London, UK) and rapid deployment (INTUITY Elite, Edwards Lifesciences, Irvine, CA, USA) valves were introduced to the market as an innovative alternative to traditional valves for patients needing aortic valve replacement (AVR). These devices have been used and studied extensively across these fifteen years, and have proven to be a valid alternative treatment option compared to sutured biological valves, particularly helpful in minimally invasive cardiac surgery, and an almost curative treatment to patients with intermediate to high surgical risk, filling the gap between transcatheter and traditional AVR. However, both sutureless and rapid deployment valves require special steps for implantation, and also a learning curve. Proper specific training to all surgical team members is required as mandatory by the manufacturers. The aim of this review article is to provide cardiac surgeons with a thorough guide on the implantation technique from A to Z, for each of these two prosthetic devices. In this second part of our review article, we will focus on the INTUITY Elite valve
Mitral Valve Repair Techniques With Neochords: When Sizing Matters
Full text linkMitral valve (MV) repair procedures have evolved over time and multiple approaches have been proposed also for the repair with neochords implantation. This article compiles the currently available approaches for implanting and sizing neochords, to restore a proper coaptation of the MV leaflets and a good systo-dyastolic movement. The described techniques are aimed at standardizing chordal measurement, in order to reduce variability in chordal length. The placement of annuloplasty ring before chordae implantation should be avoided. Regardless of the technique chosen, it is important that the implanted chordae do not interfere with normal native chordae, to avoid the risk that neochordae may heal together or get damaged. This article aims to give an overview of the most common sizing techniques available
Minimally invasive aortic valve surgery
Full text linkSince their introduction, it has been demonstrated that minimally invasive aortic valve replacement (MIAVR) approaches are safe and effective for the treatment of aortic valve diseases. To date, the main advantage of these approaches is represented by the reduced surgical trauma, with a subsequent reduced complication rate and faster recovery. This makes such approaches an appealing choice also for frail patients [obese, aged, chronic obstructive pulmonary disease (COPD)]. The standardization of the minimally invasive techniques, together with the implementation of preoperative workup and anesthesiological intraand post-operative care, led to an amelioration of surgical results and reduction of surgical times. Moreover, the improvement of surgical technology and the introduction of new devices such as sutureless and rapid deployment (SURD) valves, has helped the achievement of comparable results to traditional surgery. However, transcatheter technologies are nowadays more and more important in the treatment of aortic valve disease, also in low risk patients. For this reason surgeons should put new efforts for further reducing the surgical trauma in the future, even taking inspiration from other disciplines. In this review, we aim to present a review of literature evidences regarding minimally invasive treatment of aortic diseases, also reflecting our personal experience with MIAVR techniques. This review could represent a tool for a well-structured patient assessment and preoperative planning, in order to safely carrying out an MIAVR procedure with satisfactory outcomes
An Easy and Reproducible Technique to Address Tricuspid Valve Regurgitation with Patch Augmentation.
No full textWe describe a patch augmentation of the anterior leaflet of the tricuspid valve to address tricuspid valve regurgitation due to leaflet retraction. The area of the anterior leaflet is measured using a tricuspid valve annuloplasty sizer; a glutaraldehyde-fixed autologous pericardial patch is trimmed with slight 5 mm oversize. The anterior leaflet is detached and the patch is sutured with three 5/0 running interlocked sutures, then an annuloplasty is performed with an undersized ring. This technique offers an easy and reproducible tool to address tricuspid regurgitation due to lack of leaflet coaptation
Are bioprostheses associated with better outcome than mechanical valves in patients with chronic kidney disease requiring dialysis who undergo valve surgery?
No full textA best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patients with chronic kidney disease who required dialysis that undergo valve surgery have better surgical recovery rates with bioprostheses than with mechanical valves. Altogether more than 96 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Patients with end stage renal disease (ESRD) undergoing cardiac surgery are very fragile, with high in-hospital mortality rates (13-36%) and limited life expectancy (15-42 months in selected studies). Two studies outlined that diabetic ESRD, neurological impairment, age at the operation and poor ventricular function are the strongest predictors of early and late morbidity and mortality. Based on American Heart Association/American College of Cardiology (AHA/ACC) 1998 valvular guidelines, bioprostheses were considered a contraindication in dialysis patients; this statement derived from anecdotal reports of accelerated valve degeneration. Structural valve deterioration was reported in only 5 of 1347 patients who received bioprosthesis through the studies and independent from implantation site. Likelihood of degeneration is low, with a calculated valve-excision rate of 7%, and occurred in a broad range of time (from 10 to 156 months). The AHA/ACC 2006 valvular revised guidelines removed the previous statement (1998) of class IIa recommendation for mechanical valves and class III for tissue valves; in the focus update of 2008, there is still no specific indication for valve selection in dialysis patients, but difficulties in maintaining anticoagulation in these patients was noted. Stroke, haemorrhage and gastro-intestinal bleeding events occurred in almost 15% of patients with mechanical valves during the follow-up, while bioprostheses showed an average event rate of 3.9%. All but one of the selected studies reported no differences in survival between mechanical and biological valves; in five of seven studies, the patients who received bioprostheses were older (mechanical vs biological average 53 years vs 61.4 years), in one study, patients had undergone dialysis for longer period of time, and, in another study, they had suffered from more previous myocardial infarction (mechanical vs biological 9.1% vs 36.2%). Therefore, survivals have been biased in favour of mechanical valves. Taking together these data, biological valves are a suitable treatment for dialysis-dependent patients and, while not superior to mechanical valves in survival due to the aforementioned study biases, exhibit lower valve-related and anti-coagulation related events. © 2012 The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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