Surgical Technology International
32nd Edition
Contains 45 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
368 pages
May 2018 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Latest Advances in Cardiac Valvular Replacement
Ruggero De Paulis, MD, PhD, Professor of Surgery, Salvatore D’Aleo, MD, Cardiac Surgeon, Ilaria Chirichilli, MD, Cardiac Surgeon, Luca Paolo Weltert, MD, Cardiac Surgeon, Heart Surgery Division, European Hospital, Rome, Italy
918
The original monograph on valvular prostheses in Surgical Technology International was published in 1993. It represents a milestone and a reference point for critically organizing information on a complex and rapidly evolving topic. The last update was published in 2010.
Since then, there have been significant developments regarding both “traditional” surgical prosthesis and valves for transcatheter implantation.
Both bioprostheses and mechanical prostheses continue to evolve with respect to both their design and materials to further optimize hemodynamics and prevent a patient-prosthesis mismatch.
Each type of prosthesis has its own Achilles’s heel: limited durability leading to structural failure for bioprostheses, and the need for anticoagulation for mechanical prostheses. After a long period of only marginal improvements, new techniques for tissue preservation and manufacturing seem to have placed surgeons on the verge of a minor revolution regarding bioprostheses. In addition, in the realm of mechanical prostheses, the many promises of silicon-free pyrolitic carbon still need to be confirmed, while an extremely cautious approach with new anticoagulants has left patients out of the non-dose-adjusted revolution, which has radically improved the quality of life of other patients, such as those suffering from atrial fibrillation.
On the other hand, transcatheter therapies are maturing, and the next few years will probably see an even stronger shift in the treatment of patients away from surgical theaters to cath labs, or perhaps to a new mixed theater (which could lead to a new mixed surgeon/catheter expert professional).
This paper provides device descriptions and images of the technologies that are considered to be predominant, at least for the moment, to help orient surgeons and to serve as a reference for students. This report would not have been possible without the prior work of Profs. Denton Cooley and Eric Jamieson.
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Transcatheter Technologies for Valvular Replacement: an Update
Antonio Nenna, MD, Resident, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Massimo Chello, MD, Full Professor of Cardiac Surgery, Sanjeet Singh Avtaar Singh, MD, Research Fellow, Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK, Simone Morganti, PhD, Professor, Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy, Laura Mazzocchi, MSc, Researcher, Ferdinando Auricchio, PhD, Professor, Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy, Francesco Nappi, MD, Consultant, Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
999
This report provides a brief overview of the basic principles, recent advances, and recommendations for the treatment of severe aortic stenosis with transcatheter aortic valve replacement (TAVR) in adults. Approaches that avoid neurological, cardiac and peripheral vascular complications have been developed. In addition, TAVR can be performed in intermediate- and low-risk patients. However, these procedures require specialized training and may not allow for complete resolution of the underlying issue. Even if cardiologists learn to perform the procedure and despite advancements in device technology, TAVR is still susceptible to structural valve degeneration, thrombosis and late cerebral embolization. To date, TAVR has shown no consistent advantage over surgical aortic valve replacement (SAVR) in intermediate- and low-risk patients.
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Percutaneous Edge-to-Edge Transcatheter Mitral Valve Repair: Current Indications and Future Perspectives
Martino Pepe, MD, PhD, Interventional Cardiologist, Annagrazia Cecere, MD, Resident in Cardiology, Pasquale D’Alessandro, MD, Resident in Cardiology, Marco Matteo Ciccone, MD, FESC, Associate Professor of Cardiology, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy, Emanuela De Cillis, MD, PhD, Interventional Cardiologist, Institute of Cardiac Surgery, University of Bari, Bari, Italy, Tommaso Acquaviva, MD, Cardiologist, Institute of Cardiac Surgery, University of Bari, Bari, Italy, Arturo Giordano, MD, PhD, Interventional Cardiologist, Invasive Cardiology Unit, “Pineta Grande” Hospital, Castel Volturno, Caserta, Italy, and Department of Invasive Cardiology, Casa di Salute “Santa Lucia”, San Giuseppe Vesuviano, Napoli, Italy, Alessandro Santo Bortone, MD, PhD, Associate Professor of Cardiology, Interventional Cardiologist, Institute of Cardiac Surgery, University of Bari, Bari, Italy
1014
Mitral regurgitation (MR) is the most prevalent valvular heart disease (VHD) and represents an important cause of heart failure. Medical therapy has a limited role in improving symptoms and does not hinder the progression of valvular disease. Surgery is the treatment of choice for severe symptomatic MR; valve repair is currently the preferred surgical approach because it reduces peri-operative mortality and ensures a good medium- to long-term survival outcome. Nevertheless, a non-negligible proportion of patients with indications for surgical correction are considered to be at prohibitive perioperative risk, mainly because of old age and multiple comorbidities. The introduction of percutaneous interventions to clinical practice has changed the natural history of this population. Percutaneous edge-to-edge transcatheter mitral valve repair (Mitraclip®, Abbott Vascular, Menlo Park, CA) is a state-of-the-art therapy for approaching MR in patients with a high surgical risk. Despite having been only recently introduced, this transvenous transfemoral percutaneous intervention has already been performed in more than 40,000 subjects worldwide, with reassuring post-operative results in terms of safety, feasibility, mortality and morbidity. Since Mitraclip® is considered to be minimally invasive, it is currently indicated in “frail” patients with severe comorbidities. We provide a critical review of the literature to clarify current indications, procedural details, patient selection criteria, and future perspectives for this innovative technique.
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The Transradial Approach for Lower Extremity Vascular Intervention
Rami O. Tadros MD, Associate Professor of Surgery, Vivek S. Prakash, MD, Vascular Surgery Resident, Melissa J. Baldwin, MD, Vascular Surgery Resident, Adam Korayem, MD, Vascular Surgery Resident, Icahn School of Medicine at Mount Sinai, New York, New York, Peter L. Faries, MD, Chief of Vascular Surgery, Vascular Surgery Department, Michael L. Marin, MD, Chair of Surgery, Surgical Department, Icahn School of Medicine at Mount Sinai, New York, New York
1018
Simultaneous technological advancements in both imaging as well as devices have resulted in an expansion of endovascular options for vascular access. In particular, radial access has traditionally been more favored for coronary interventions; its use in the aortoiliac and lower extremity vasculature has been constrained by the length of devices and the size of sheaths required. However, with increasing catheter shaft lengths, in addition to new thin-walled sheaths allowing for downsizing, the ability to perform transradial interventions on infrainguinal and infrageniculate vessels has been more readily facilitated. In this review, we analyze the potential for transradial therapies in the treatment of peripheral arterial disease (PAD).
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Use of a NobleStitch™ EL Device for PFO Closure
Emanuela de Cillis, MD, PhD, Interventional Cardiologist, Tommaso Acquaviva, MD, Chief of Echo Laboratory, Pasquale D’Alessandro, MD, Fellow of Interventional Laboratory, Alessandro Santo Bortone MD, PhD, FESC, FAHA, FACC, Assistant Professor, Department of Emergency and Organs Transplantation, University of Bari, Bari, Italy
997
Cryptogenic stroke is the final diagnosis in almost 40% of ischemic acute cerebrovascular events. There is currently no definitive clinical evidence that percutaneous closure of patent foramen ovale (PFO) can prevent the recurrence of stroke or transient ischemic attack (TIA). Identification of the causes of neurologic ischemic syndromes is essential for any strategy intended to prevent the catastrophic consequences of cerebral infarction.
Since the initial reports of an unexpectedly high prevalence of PFO in younger patients with cryptogenic stroke in 1988, there has been growing interest and experience in diagnosing and treating these patients, both medically and/or with percutaneous closure, in particular for the potential to eliminate paradoxical embolism via PFO, which is a likely mechanism for stroke in these patients. Selection of the appropriate occluder device is of paramount importance for the success of the procedure. While devices like the Amplatzer™ PFO Occluder (St. Jude Medical), which, based on the extended follow-up of the RESPECT Trial, was approved by the U.S. Food and Drug Administration last year for recurrent stroke prevention, have become generally accepted as being better than medical therapy for patients needing treatment, concerns remain regarding device- and procedure-related complications. NobleStitch™ EL is a novel device that offers a simple non-prosthetic implant method of PFO closure without the inherent risks seen with septal occluders: no risk of device embolization, device thrombosis or late erosion, and probably no risk of arrhythmia. Futhermore, there is no material that would hinder future access to the left atrium and no requirement for anti-coagulation.
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Is There a Role for VATS Sleeve , Lobectomy in Lung Cancer?
Natalie N. Merchant, BS, Medical Student, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California , Robert McKenna Jr, MD, Medical Director, Thoracic Surgery Department, John Wayne Cancer Institute, Santa Monica, California, Osita Onugha, MD, MBA, Assistant Professor, Thoracic Surgery Department, John Wayne Cancer Institute, Santa Monica, California
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Lung cancer is the second most commonly diagnosed cancer and continues to be the leading cause of death for both men and women, with non-small cell lung cancer (NSCLC) accounting for 85% of all lung cancer cases. Once a lung mass is visualized on imaging, accurate staging is required for determination of treatment options and, when possible, surgical resection is recommended as it has been proven to have the best survival rates versus non-surgical treatment. If a patient has advanced or metastatic disease, therapeutic options include chemotherapy and radiation, while immunotherapy and specific agents that target tumor mutations are only recommended for appropriate candidates. Additionally, surgical options differ based on whether the tumor is peripherally or centrally located in the lung parenchyma. This article will review relevant literature concerning current surgical techniques for resection of centrally located NSCLC using thoracotomy and will emphasize the benefits and challenges of a video-assisted thoracic surgery (VATS) approach.
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