Surgical Technology International
44th Edition
July 2024 - ISSN:1090-3941
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The Mitris RESILIA Valve: New Skin for a Proven Design
Giulia Ciccarelli, MD , University of Padua, Padua, Italy, Luca Weltert, MD, Professor , Raffaele Scaffa, MD, Andrea Salica, MD, Alessandro Bellisario, MD, Alessandro Ricci, MD, Salvatore D’Aleo, MD, Samuel Fusca, MD, Lorenzo Guerrieri Wolf, MD, Giulio Folino, MD, European Hospital, Rome, Italy, Gino Gerosa, MD3, Professor, Padua University Medical School, Padova, Italy, Ruggero De Paulis, MD4, Professor, UniCamillus—Saint Camillus International University of Health Sciences, Rome, Italy
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By incorporating the best features of the Carpentier-Edwards PERIMOUNT Magna Mitral Ease valve (Edwards Lifesciences Corporation, Irvine, California) and INSPIRIS RESILIA tissue (Edwards Lifesciences Corporation, Irvine, California), the mitris valve inherits the advantages of the remarkable hemodynamic performance of the former and the durability of the latter. In this paper, we will summarize the process that led to the creation of this new valve and report on the first implant’s feasibility and first impression. The mitris valve has an overall implantability profile, overlapping the previous generation with no added challenges, but compared to the PERIMOUNT Magna Mitral Ease valve, the mitris valve boasts a more pliable saddle-shaped sewing cuff that is specifically tailored to fit the complex structure of the mitral valve with a lower stent height. This could be particularly beneficial in the context of double-valve replacement, as it may prevent any disturbance to the bioprosthesis located in the aortic position in small annulus. This could also prevent some rare but unpleasant complications such as left ventricle outflow obstruction or rupture of the atrioventricular sulcus. In addition, it could allow for better adherence to the saddle-shaped annulus of the mitral valve with the possibility of less stress (and therefore fibrosis) on the valve tissue, while further reducing the degeneration time. Furthermore, thanks to the possibility of being temporarily adjusted inwards, it is possible to ensure greater implantability compared to the previous generation of Magna Edwards mitral valves. Thanks to INSPIRIS technology, which prevents the generation of free aldehydes that promote oxidation and calcification of pericardial tissue, it is possible to assume that the durability will probably also improve. This reinforces the trustworthiness of the mitris valve.
The New Era of Three-Dimensional Annuloplasty Devices for Mitral Valve Repair: Rationale and First Experiences
Mario Torre, MD, Alberto Bonadies, MD, University of Naples Federico II, Naples, Italy, Luca Weltert, MD, Professor , Raffaele Scaffa, MD, Andrea Salica, MD, Giulio Folino, MD, Alessandro Ricci, MD, Salvatore D’Aleo, MD, Lorenzo Guerrieri Wolf, MD, Samuel Fusca, MD, Alessandro Bellisario, MD, Marianna Primiterra, MD, Ruggero De Paulis, MD, Professor , European Hospital, Salerno, Italy, Francesco Irace, MD, Ilaria Chirichilli, MD, University of Padua, Padua, Italy
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Annuloplasty should always accompany mitral valve repair in order to achieve proper annular remodeling and stabilization. Numerous types of annuloplasty rings—that differ from rigid to semi-rigid and flexible devices, from complete to partial, and from flat to saddle-shaped rings—are clinically available. A deeper understanding of mitral valve function, in conjunction with several recent studies, suggest it is advisable to prefer annuloplasty rings that mimic the physiological mitral annulus shape and three-dimensional (3D) dynamic changes in order to reduce haemodynamic stress on valve components and optimize leaflet coaptation, perhaps improving valve repair durability too.
This paper aims to focus on 3D annuloplasty rings, with dynamic features: MEMO 3D™ and MEMO 4D™ (Sorin Medical, New York, New York), as well as Physio Flex (Edwards Lifesciences, Irvine, California).
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Outcomes of Femoral Popliteal Bypass in Octogenarians
James Hu, MD, Paul Lajos, MD, MBA, Associate Professor, Montefiore Medical Center, Bronx, New York, Scott Safir, MD, Assistant Professor, New York University Langone Hospital, Mineola, New York, Ronald Bangiyev, MPH, MBS, Rutgers New Jersey Medical School, Newark, New Jersey, Jonathan Weber, MPH, PhD, Saint Francis Hospital, Roslyn, New York, Peter Faries, MD5, Professor, Ageliki Vouyouka, MD, Professor, The Mount Sinai Hospital, New York, New York
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Introduction: Femoral-popliteal bypass (FPB) surgery is a common lower extremity revascularization procedure. As the population continues to age, this procedure is being performed increasingly on older patients. This study investigated whether outcomes differ in this population.
Materials and Methods: Patients over and less than 80 years old who underwent FPB between 2009–2013 were queried using an existing hospital registry. Demographics, comorbidities, intraoperative complications, perioperative outcomes, and two-year patencies were compared.
Results: Twenty-four patients in the octogenarian cohort (OC) and 72 patients in the non-octogenarian cohort (NOC) were identified. There was a lower prevalence of smoking (p=0.018) and higher prevalence of hypertension (p=0.021) among octogenarians. Other medical characteristics were similar (p<0.05). There were no differences in use of vein versus PTFE (p=0.002) as a conduit, or above (OC 20.0% vs. NOC 36.7%), versus below knee (OC 80.0% vs. NOC 63.3%) distal anastomosis (p>0.05) between the groups. There was a difference (p<0.01) in indication for procedure (OC/NOC): claudication (0%/44%), limb salvage (71%/31%), and rest pain (29%/25%). There were no differences in 30-day readmissions (17% vs. 21%; p=0.59) or incidence of postoperative (25% vs. 19%; p=0.56) or intraoperative complications (8.3% vs. 4.2%; p=0.52). Length of stay (LOS) was longer and statistically significant in octogenarians (12 days vs. 7 days; p=0.032) and remained significant after multivariate linear regression (p=0.015). Patencies in OC were lower and dropped faster after six months; however, there were no statistically significant differences in patencies at any time interval (p>0.05). The position of the distal anastomosis relative to the knee, conduit type, and indication were not independently predictive of patency outcomes (p>0.05).
Conclusion: The safety and efficacy of FPB in octogenarians is similar to the general population despite LOS in octogenarians being 5.98 days longer. While the difference in indication suggests that vascular surgeons are more conservative in treating octogenarians, our analysis did not reveal significant differences between populations and suggests that lower extremity bypass can be performed safely with comparable results in this cohort. A larger cohort is needed to validate these results.
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The Ross Operation Over 55 Years Later: Comparing Surgical Techniques and Outcomes
Francesco Nappi, PhD, MD, Centre Cardiologique du Nord, Saint-Denis, France
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The Ross procedure is often considered the best option for a small group of patients. Some critics argue that harvesting the pulmonary artery again can cause problems, such as exposing the native pulmonary autograft to systemic pressures and requiring further intervention. However, the pulmonary autograft is a living tissue that can adjust to growing conditions and undergo remodelling. The pathophysiology of living tissue, harvesting techniques, indications for use of pulmonary autograft in aortic valve disease, contraindications, and variations of pulmonary autograft as an aortic conduit are discussed in this seminar. Following recent updates from high-volume centres, the indications, contraindications, techniques, and variations of pulmonary autograft as an aortic conduit and, in the absence of substantial well-designed randomised controlled trials, areas where the Ross procedure needs to be reaffirmed as part of the surgical armamentarium are also discussed. Furthermore, increasing evidence suggests that the Ross procedure produces better long-term results than traditional aortic valve replacement in young and middle-aged adults. To enable cardiologists and surgeons to make appropriate decisions for their patients with aortic valve disease, the author provides a complete review of the most recent published studies on the Ross procedure.
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Advancements in Donation after Circulatory Death Heart Procurement and Preservation: A Comprehensive Review of Recent Innovations
Ignazio Condello, PhD, Director of Perfusion Service, Department of Cardiac Surgery, Anthea Hospital GVM Care & Research, Bari, Italy
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Introduction: The persistent shortage of donor hearts for transplantation has prompted exploration into Donation after Circulatory Death (DCD) as a promising avenue for organ procurement. This comprehensive review aims to examine recent advancements in DCD heart procurement and preservation techniques to address the critical need for donor organs and improve transplant outcomes.
Materials and Methods: A systematic review was conducted to identify relevant studies and innovations related to DCD heart procurement and preservation. Electronic databases including PubMed, MEDLINE, and Google Scholar were searched using keywords such as “DCD heart donation,” “organ preservation,” and “transplantation.” Studies with statistical analyses on transplant outcomes were included for further evaluation.
Results: A meta-analysis of DCD heart transplantation outcomes revealed a statistically significant increase in successful transplants utilizing hearts procured after circulatory death (p<0.05). Normothermic machine perfusion demonstrated a 20% reduction in ischemic time compared to traditional cold storage methods, leading to improved post-transplant cardiac function and reduced rates of primary graft dysfunction. These findings highlight the potential of DCD heart procurement and preservation techniques to address the critical shortage of donor hearts while enhancing transplant outcomes.
Conclusion: Recent innovations in DCD heart procurement and preservation techniques show promise in overcoming the challenges of donor organ scarcity and improving transplant success rates. Continued research and development in this field are essential to further optimize these techniques and meet the growing demand for donor hearts worldwide.
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The Importance of Digital Lung Tomosynthesis in Overcoming Computed-Tomography-to-Body Divergence During Bronchoscopic Biopsies of Peripheral Lung Nodules
Amit “Bobby” Mahajan, MD, FCCP, DAABIP, Inova Health System, Falls Church, Virginia, Joseph Cicenia, MD, Cleveland Clinic Fairview Hospital, Cleveland, Ohio, Douglas K. Hogarth, MD, FCCP, Professor of Medicine, The University of Chicago Medical Center, Chicago, Illinois, Omar Ibrahim, MD, DAABIP, University of Connecticut Health, Farmington, Connecticut, Tao Zhao, APAC, Noah Medical Company, San Fernando, California, Krish Badra, MD, CHI Memorial Rees Skillern Cancer Institute, Chattanooga, Tennessee
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The advent of robotic bronchoscopy coupled with electromagnetic navigation bronchoscopy (EMN) and shape-sensing technology have increased diagnostic yields for peripheral pulmonary nodules compared to traditional bronchoscopy. Yet, diagnostic yields from these bronchoscopic platforms still fall short of where they should be. This shortfall is in large part due to a lack of advanced imaging during peripheral bronchoscopy and computed tomography (CT)-to-body divergence (CTBD). Digital lung tomosynthesis (DLT) is an advanced imaging modality that helps overcome CTBD during bronchoscopic biopsies of lung nodules. DLT is a quasi-3D imaging technique, which reconstructs tomographic images of the lung from a series of 2D fluoroscopic projection images. These images can be acquired either using a digital flat panel fluoroscopy machine or a fluoroscopy machine with a more traditional image-intensifier present in most standard bronchoscopy suites. This review aims to explain the mechanisms of both CTBD and DLT to help diagnose early-stage lung cancer more effectively.
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