Surgical Technology International
34th edition
Contains 67 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
521 pages
May 2019 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Cardiothoracic and Vascular Surgery
FOREWORD by Volkmar Falk, MD, Director of the Department of Cardiothoracic Surgery, Charité, Universitätsmedizin Berlin, Berlin, Germany
Transcatheter Valve-in-Valve and, Valve-in-Ring Interventions for Failing Bioprostheses and Annuloplasty Rings
Markus Kofler, MD, Resident, German Heart Center Berlin, Berlin, Germany, Medical University of Innsbruck, Innsbruck, Austria, Axel Unbehaun, MD, Senior Consultant, Christoph Klein, MD, Senior Consultant, Alexander Meyer, MD, Resident, Semih Buz, MD, Senior Consultant, Volkmar Falk, MD, Medical Director, Jörg Kempfert, MD, Senior Consultant, Department of Cardiothoracic, and Vascular Surgery, German Heart Center Berlin, Berlin, Germany, Department of Cardiothoracic Surgery, Charité, Universitätsmedizin Berlin, DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany, Matthias Hommel, MD, Senior Consultant, German Heart Center Berlin, Berlin, Germany
1076
Transcatheter aortic valve implantation has dramatically changed the treatment of valvular heart disease over the past decade. At the same time, the indications for bioprosthesis implantation have been continuously extended toward younger patients, driven by excellent clinical results and improved durability. While the omission of oral anticoagulation reduces the risk of severe bleeding complications, the long-term durability of bioprostheses is still limited. In light of the growing number of elderly transcatheter aortic valve replacement (TAVR) patients, the prevalence of patients with failed bioprostheses and advanced comorbidities is expected to rise. Currently, transcatheter valve-in-valve (ViV) and valve-in-ring (ViR) interventions represent a valuable alternative treatment option for patients with a high risk for surgical reoperation. Several reports have described a high procedural success rate and low postprocedural morbidity and mortality during mid-term follow-up. We are still facing valve-specific and procedure-related challenges in all types of procedures, but especially in transcatheter ViR interventions. Considering the high technical demand of these interventions, a strong and highly specialized heart team in heart valve centers is the cornerstone of successful patient treatment. This review focuses on individualized patient selection, procedure-specific risk factors and technical aspects of transcatheter ViV/R interventions, and explores the currently available literature on postinterventional outcome.
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Transcatheter Tricuspid Valve Interventions: Current Approaches and Future Perspectives
Antonio Nenna, MD, Resident in Cardiac Surgery, Massimo Chello, MD, Full Professor of Cardiac Surgery, Consultant Cardiac Surgeon, Università Campus Bio-Medico di Roma, Rome, Italy, Sanjeet Singh Avtaar Singh, MD, Clinical Fellow in Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom, Pierluigi Nappi, MD, Resident in Cardiology, University of Messina, Messina, Italy, Francesco Nappi, MD, Consultant Cardiac Surgeon, Centre Cardiologique du Nord, Saint-Denis, Paris, France
1131
Tricuspid valve regurgitation is generally functional in nature due to right-sided dysfunction in the setting of left-sided concomitant cardiac disease or pulmonary hypertension. Patients living with tricuspid regurgitation often experience numerous limitations as a result of right-sided heart failure symptoms. Patients with significant tricuspid disease, whether native, repaired, or replaced valve, often present with significant symptoms but may not be ideal candidates for operation or, eventually, reoperation. Transcatheter techniques to either repair or replace the tricuspid valve are a burgeoning frontier in structural cardiac interventions. Anatomical challenges include the large and asymmetrical annulus, paucity of calcification, adjacency of the right coronary artery system, and fragility of the valve tissue. Current approaches under investigation in feasibility and early phase clinical trials include edge-to-edge repair, coaptation enhancement, annuloplasty, heterotopic caval valve implantation, and percutaneous tricuspid valve replacement. Although there are limitations to the currently available transcatheter options for the patients, the initial data demonstrate the relative safety of using existing devices with good results and functional improvement. Hopefully, the emerging interest into interventional therapy of tricuspid valve disease will bring back the “forgotten valve” into the conscience of the cardiological and surgical community. This review intends to summarize the current strategies and evidences in transcatheter tricuspid valve intervention and enlightening new avenues for future clinical studies.
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Clinical Outcomes of Patients with Severe Aortic Valve Stenosis Treated with Portico,
Transcatheter Aortic Valve System
Alberto Pozzoli MD, Maurizio Taramasso MD PhD, Mizuki Miura MD PhD, Gökhan Gülmez MD,
Shu-I Lin MD, Mara Gavazzoni MD, Francesco Maisano MD, Heart Valve Clinic, University Hospital
of Zurich, University of Zurich, Zurich, Switzerland, Phillip Haager MD, Cardiology Department,
Hans Rickli MD, Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
1119
The Portico™ transcatheter aortic valve implantation (TAVI) system (Abbott Vascular, Santa Clara, CA, USA) was specifically designed to reduce some of the limitations associated with first-generation TAVI devices. Most of the currently available clinical evidence was obtained from randomized studies that compared TAVI to aortic valve replacement using first-generation transcatheter heart valve devices. The aim of this review is to describe the characteristics of the repositionable and retrievable Portico™ system and the technique of implantation, as well as to provide an overview of the most recent outcomes in the literature, along with our institutional experience.
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Fibonacci’s Golden Ratio―An Innovative Approach to the Design and Management of Extra - Corporeal Circulation
Ignazio Condello, ECCP, Chief of Clinical Perfusion, Giuseppe Nasso, MD, Chief of Cardiovascular Surgery, Flavio Fiore, MD, Chief of Cardiac Surgery, Anesthesia and ICU, Seanne Azzolina, ECCP, Chief of Clinical Perfusion, Raffaele Bonifazi, MD, Cardiovascular Surgeon, Nicola Di Bari, MD, Cardiovascular Surgeon, Fabrizia Massaro, MD, Cardiac Surgery, Anesthesia and ICU, Giuseppe Speziale, MD, Head of Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy, Francesco Bartolomucci, MD, Cardiologist, ASL BAT, Andria, Italy
1104
Technological advances in the field of extracorporeal circulation (ECC) over the past decade have led to numerous methods for monitoring metabolism and coagulation during cardiopulmonary bypass (CPB), as well as materials with improved biocompatibility, which has reduced the risk associated with cardiopulmonary bypass. However, ECC is still predominantly based on a traditional design that involves the use of roller pumps. This exposes the patient to a variety of pathophysiological consequences, both intra- and postoperative, such as postoperative cognitive disorders, hemolysis and hemodilution, systemic inflammation and changes in coagulation. This article describes the advantages of an ECC circuit inspired by the Fibonacci Golden Ratio, which does not use a roller pump, in a prospective study on patients undergoing elective cardiac surgery, compared to conventional ECC. During CPB, echocardiography was used to estimate the quality of fluid dynamics in the extracorporeal circuit and the patient's arterial vessels, a DO2 management system was used to evaluate metabolism, and an electronic system was used to determine gaseous microemboli (GME) counts. Fibonacci ECC offered superior intraoperative fluid dynamics, reduced the production of and improved the elimination of GME, and improved intraoperative metabolism, particularly with regard to oxygen delivery and extraction. The improvements in fluid dynamics and metabolic variables were associated with a reduction in the incidence of pathophysiological events compared to the conventional system, particularly regarding transitory cognitive disorders, and a shorter stay in intensive care.
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The Epidemiology, Pathophysiology, and Novel Treatment of Calcific Arterial Disease
Lucyna Z. Price, MD, Surgical Fellow, Peter L. Faries, MD, Chief of Vascular Surgery, Krishnan Prakash, MD, Assistant Professor of Medicine, Jason C. Kovacic, MD, PhD, Associate Professor, Mount Sinai Hospital, New York, New York, James F. McKinsey, MD, Vice Chairman of Surgery, Mount Sinai West, Chief of Complex Aortic Intervention, Mount Sinai Health System, The Icahn School of Medicine at Mount Sinai, New York, New York, Gilbert HL Tang, MD, MBA, Associate Professor, Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, Surgical Director, Structural Heart Program, Mount Sinai Health System, New York, New York, Rami O. Tadros, MD, FACS, RPVI, Associate Program Director of Vascular Surgery, Associate Professor of Surgery and Radiology, Director, Off-site Vascular Lab, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, New York, New York
1103
Endovascular treatment of arterial diseases has become first-line in most cases due to improved technology. However, until recently, excessive atherosclerotic calcification has been a major limiting factor in the endovascular management of peripheral arterial disease, as well as vascular access for endovascular aneurysm repair (EVAR) and transcatheter aortic valve replacement (TAVR). The Peripheral Intravascular Lithotripsy (IVL) System (Shockwave Medical, Inc., Fremont California) applies pulsatile mechanical energy under fluoroscopic guidance to disrupt calcified lesions. The purpose of this paper is to introduce IVL in the treatment of calcific access vessels in preparation for EVAR and TAVR, as well as peripheral arterial disease applications to enhance luminal gain. Using the IVL System, angioplasty can be performed with lower pressures, which may minimize arterial dissection. Further, the lithotripsy effect on calcium will enhance vessel compliance. We describe several cases where IVL was applied successfully and present additional cases that may have benefitted from the use of this technology.
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Percutaneous Thermal Ablation for Lung Cancer: An Update
Zachary J. Hartley-Blossom, MD, MBA, Resident, Terrance T. Healey, MD, Director of Thoracic Radiology, Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI
1092
Lung cancer remains the leading cause of cancer death in the United States, and accounts for more deaths than breast, colon, and prostate cancer combined. Over the past decade, percutaneous thermal ablative therapy (PTA) has become a useful adjunctive therapy in combination with longer-standing methods, or as a standalone treatment.
The physiologic basis of thermal ablation is that coagulative necrosis and cell death occur at temperatures above 60°C. During treatment, PTA of lung tumors routinely achieves temperatures above 70°C. Radiofrequency ablation has fallen out of favor in recent years as microwave ablation has been proven to be effective, with shorter treatment times.
Pulmonary PTA is a routine outpatient procedure in which conscious sedation is used in lieu of general anesthesia. The first post-procedural follow-up imaging is CT at 4 weeks, coinciding with an office visit.
In our most recent review of long-term results, which included 108 patients, all-cause survival at 1, 2, and 3 years was 83%, 59%, and 43%, respectively. When we specifically considered cancer-related survival, these numbers increased to 94%, 79%, and 57%.
Percutaneous thermal ablation has been shown to be a safe and effective treatment for patients with early-stage NSCLC who are not candidates for surgery, as well as a potential treatment for local small cell lung cancers. As the field of oncology, and specifically the treatment of lung cancer, continues to evolve, PTA will represent a useful tool in the arsenal.
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