OBJECTIVE: To report the early and mid-term results of patients who underwent minimally invasive aortic valve replacement (MI-AVR) with a sutureless prosthesis from an international prospective registry. METHODS: Between March 2011 and September 2018, among 957 patients included in the prospective observational SURE-AVR (Sorin Universal REgistry on Aortic Valve Replacement) registry, 480 patients underwent MI-AVR with self-expandable Perceval aortic bioprosthesis (LivaNova PLC, London, UK) in 29 international institutions through either minithoracotomy (n = 266) or ministernotomy (n = 214). Postoperative, follow-up, and echocardiographic outcomes were analyzed for all patients. RESULTS: Patient age was 76.1 ± 7.1 years; 64.4% were female. Median EuroSCORE I was 7.9% (interquartile range [IQR], 4.8 to 10.9). Median cardiopulmonary bypass and cross-clamp times were 81 minutes (IQR 64 to 100) and 51 minutes (IQR 40 to 63). First successful implantation was achieved in 97.9% of cases. Two in-hospital deaths occurred, 1 for noncardiovascular causes and 1 following a disabling stroke. In the early (≤30 days) period, stroke rate was 1.4%. Three early explants were reported: 2 due to nonstructural valve dysfunction (NSVD) and 1 for malpositioning. One mild and 1 moderate paravalvular leak were reported. In 16 patients (3.3%) pacemaker implantation was needed. Mean follow-up was 2.4 years (maximum = 7 years). During follow-up 5 explants were reported, 3 due to endocarditis and 2 due to NSVD. Follow-up stroke rate was 2.5%. Three structural valve deteriorations not requiring reintervention were reported. Five-year survival was 91.45%. CONCLUSIONS: In this large prospective international registry, MI-AVR with Perceval valve confirmed to be safe, reproducible, and effective in an intermediate-risk population, providing excellent clinical recovery both in early and mid-term follow-up.
- Klíčová slova
- MICS, aortic stenosis, sutureless,
- MeSH
- aortální stenóza chirurgie MeSH
- bezstehová chirurgie metody statistika a číselné údaje MeSH
- bioprotézy MeSH
- chirurgická náhrada chlopně metody statistika a číselné údaje MeSH
- echokardiografie metody MeSH
- kardiochirurgické výkony metody MeSH
- kardiopulmonální bypass statistika a číselné údaje MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- prospektivní studie MeSH
- protézy - design trendy MeSH
- registrace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční chlopně umělé MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
OBJECTIVE: An aortic annuloplasty ring could be useful for aortic valve repair. This trial evaluated intermediate-term outcomes of internal geometric ring annuloplasty for repair of trileaflet and bicuspid aortic insufficiency associated with ascending aortic and/or aortic root aneurysms. METHODS: Under regulatory supervision, 47 patients with aortic insufficiency and ascending aortic (n = 22) and/or aortic root (n = 25) aneurysms were managed with aortic valve repair and aneurysm resection. Valve repair was performed using trileaflet (n = 40) or bicuspid (n = 7) internal geometric rings, together with leaflet reconstruction. Ascending aortic and/or remodeling root replacements were accomplished with Dacron grafts 5 to 7 mm larger than the rings. An Echo Core Lab provided independent echocardiographic assessments, and changes over time were evaluated by Friedman tests. RESULTS: Mean ± SD age was 60 ± 14 years, 57% (27/47) were male, 15% (7/47) had bicuspid valves, 87% (41/47) had moderate-to-severe aortic insufficiency, and 13% (6/47) had mild aortic insufficiency. All patients had annular dilatation, with a mean ± SD of 26.5 ± 2.6 mm before repair, and mean ± SD ring sizes were 21.7 ± 1.7 mm. Follow-up was 42 months (mean = 27 months). No operative mortality or valve-related complications occurred. Two patients died beyond 1 year from nonvalve-related causes. One patient required valve replacement for repair failure. Survival free of complications or valve replacement was 94% at 2 years. Significant reduction in aortic insufficiency and New York Heart Association class were observed (P < 0.0001), and valve gradients remained low. No heart block or direct ring complications occurred. CONCLUSIONS: In preliminary regulatory studies, aortic ring annuloplasty seemed safe and effective during aortic aneurysm surgery. This approach could help standardize aortic valve repair.
- MeSH
- anuloplastika srdeční chlopně * škodlivé účinky přístrojové vybavení mortalita statistika a číselné údaje MeSH
- aortální aneurysma mortalita chirurgie MeSH
- aortální chlopeň chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace MeSH
- protézy - design MeSH
- reoperace MeSH
- senioři MeSH
- srdeční chlopně umělé škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Left atrial appendage (LAA) plays a crucial role in the etiopathogenesis and the prevention of the stroke in patients with nonvalvular atrial fibrillation (AF). This paper presents our first experience with thoracoscopic LAA occlusion using an external clip. METHODS: We performed a total of 30 LAA occlusions with the AtriClip from left thoracoscopy approach during the period from July 2012 to July 2013. AtriClip was implanted during the bilateral thoracoscopic radiofrequency (RF) as part of left atrial ablation procedure. RESULTS: Among the 30 procedures, AtriClip was once periprocedurally partially positioned. In the remaining procedures, the implantation was successful without complications. Of the 30 patients, 29 underwent transesophageal echocardiography and computer tomography examination at 3 months after the procedure. Apart from the patient with the partial clip placement, a residual pouch of 18 mm was detected in another patient. In the remaining group (28/30 patients, 93%), the exclusion was complete. No migration or any other clip implantation-related complications occurred during the follow-up. None of the patients experienced an embolization event. CONCLUSIONS: Endoscopic AtriClip implantation appears to be a reproducible and safe method of LAA occlusion, with a minimal risk and a high efficiency. In our opinion, the AtriClip implantation is a reasonable part of thoracoscopic AF treatment and should be considered as an alternative tool for stroke risk reduction in patients with AF.
- MeSH
- cévní mozková příhoda prevence a kontrola MeSH
- echokardiografie transezofageální metody MeSH
- fibrilace síní chirurgie MeSH
- katetrizační ablace metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- pooperační komplikace MeSH
- protézy a implantáty * MeSH
- senioři MeSH
- síňové ouško chirurgie MeSH
- torakoskopie metody MeSH
- tromboembolie patofyziologie prevence a kontrola MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- hrudní chirurgické výkony * MeSH
- kardiovaskulární chirurgické výkony * MeSH
- kongresy jako téma * MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony * metody MeSH
- periodika jako téma MeSH
- společnosti lékařské MeSH
- vůdcovství * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodníky MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- hrudní chirurgické výkony * MeSH
- kardiochirurgické výkony * MeSH
- kongresy jako téma MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- periodika jako téma normy MeSH
- vůdcovství MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodníky MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: The feasibility of robotically assisted laparoscopic aortic surgery has already been adequately demonstrated. Our clinical experience with robot-assisted aortoiliac reconstruction for occlusive diseases, aneurysms, and hybrid procedures performed using the Da Vinci system is described below. METHODS: Between November 2005 and November 2011, we performed 225 robot-assisted laparoscopic aortoiliac procedures. One hundred seventy-four patients were prospectively evaluated for occlusive diseases, 43 patients for abdominal aortic aneurysm, two for common iliac artery aneurysm, two for splenic artery aneurysm, three for hybrid procedures, and one for endoleak II treatment after endovascular aneurysm repair. The robotic system was applied to construct the vascular anastomosis for thromboendarterectomy, for aortoiliac reconstruction with a closure patch, for dissection of the splenic artery, and for posterior peritoneal suturing. A combination of conventional laparoscopic surgeries and robotic surgeries was routinely included. A modified fully robotic approach without laparoscopic surgery was used in the last 55 cases in our series. RESULTS: Two hundred seventeen cases (96%) were successfully completed robotically; one patient's surgery was discontinued during laparoscopy because of heavy aortic calcification. In seven patients (3%), conversion was necessary. The 30-day mortality rate was 0.4%, and nonlethal postoperative complications were observed in 10 patients (4.4%). CONCLUSIONS: Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for aortoiliac vascular and hybrid procedures. Compared with purely laparoscopic techniques, the Da Vinci robotic system facilitated the creation of the aortic anastomosis and shortened the aortic clamping time.
- MeSH
- anastomóza chirurgická metody MeSH
- aneurysma břišní aorty mortalita chirurgie MeSH
- aneurysma ilické tepny mortalita chirurgie MeSH
- aneurysma chirurgie MeSH
- arteria lienalis chirurgie MeSH
- arteriální okluzní nemoci chirurgie MeSH
- dospělí MeSH
- endarterektomie metody MeSH
- kardiovaskulární nemoci chirurgie MeSH
- laparoskopie * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- robotika * MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- výkony cévní chirurgie přístrojové vybavení MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: : Evolving technologies of proximal anastomosis devices meet the endeavor of surgeons to minimize manipulation of the ascending aorta during surgical myocardial revascularization. The objective of this study was to compare the patency rate of the saphenous vein coronary bypass grafts in which the proximal anastomoses were performed with automatic connector devices to the suture technique. METHODS: : From September 2002 through July 2003, 86 patients underwent coronary artery bypass grafting with at least 1 vein graft anastomosed to the ascending aorta with the Symmetry G2 connector. Six-month clinical and angiographic follow-up, including Core-Lab quantitative coronary angiography (QCA) and corrected TIMI frame count (CTFC), was performed. RESULTS: : Eighty patients had at least 1 connector successfully implanted. Freedom from MACE (cardiac mortality myocardial infarction and target vessel reintervention) was 72/80 (90%). Six patients underwent a target vessel reintervention on the connector grafts. Six-month (mean 193 ± 36 days) angiography patency rates for the connector grafts were 72/81 (88.89%), 37/40 (92.5%) in sutured grafts, and 60/62 (96.8%) in arterial grafts. By QCA, 64/65 (98.5%) patent connector-grafts were free from more than 50% stenosis (1 connector-graft with a 51% stenosis). CTFC showed 65/65 (100%) patent connector-grafts with nonrestrictive flow. CONCLUSIONS: : Saphenous vein grafts anastomosed to the aorta with the Symmetry G2 connector have early and midterm patency rates comparable to the conventional sutured anastomoses. These results support the efficiency of the second generation of symmetry aortic connectors.
- Publikační typ
- časopisecké články MeSH
