保留胸骨主动脉瓣的双尖瓣无缝合线置换术。

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Michel Pompeu Sá, Jef Van den Eynde, Ozgun Erten, Serge Sicouri, Basel Ramlawi
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引用次数: 0

摘要

在过去的十年中,无缝线瓣膜(Perceval, LivaNova PLC)被引入市场,作为需要手术主动脉瓣置换术(SAVR)的患者支架瓣膜的替代方案。然而,Perceval对植入有特殊的要求,其中我们可以提到对手术团队成员的具体培训。保留胸骨的心脏手术被认为是为了减少手术创伤,但技术要求和术前计划比传统的胸骨切开术更具挑战性。SAVR通常通过上半胸切开术进行,但右前胸切开术(RAT)是一种创伤更小的技术进步。在SAVR和RAT的背景下,Perceval被认为是“完美的婚姻”。对于双尖瓣主动脉瓣(BAV)患者,一些外科医生最初避免使用Perceval瓣膜,但随着经验的增长,该假体已广泛用于各种适应症。根据最近发表的一项国际共识声明,BAV有3种类型:融合型BAV、2-窦型BAV和部分融合型BAV,每种类型都有特定的表型。双窦BAV有2个尖头,大小和形状大致相等,每个尖头占环周180°,只有2个主动脉窦,形成无缝的2窦/2尖头瓣,连接角为180°。由于BAV患者的椭圆主动脉环对无缝合线瓣膜构成挑战,并且RAT入路越来越多地用于微创SAVR,因此我们对手术技术的描述侧重于2窦BAV外侧表型情况下的具体手术细节。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sternal-sparing aortic valve replacement with sutureless valve in bicuspid valve.

Over the last decade, sutureless valves (Perceval, LivaNova PLC) were brought to the market as an alternative to stented valves for patients requiring surgical aortic valve replacement (SAVR). However, Perceval demands special steps for implantation, among which we can mention specific training for the surgical team members. Sternal-sparing cardiac procedures are conceived to limit surgical trauma, but the technical requirements and preoperative planning are more challenging than those for conventional sternotomy. SAVR is frequently carried out through an upper hemisternotomy, but the right anterior thoracotomy (RAT) represents an even less traumatic, technical advancement. In the context of SAVR with RAT, Perceval has been considered the "perfect marriage." In patients with bicuspid aortic valve (BAV), some surgeons initially avoided the Perceval valve but, with growing experience, the prosthesis has been used for a wide variety of indications. According to an international consensus statement recently published, there are 3 BAV types: the fused BAV, the 2-sinus BAV and the partial-fusion BAV, each with specific phenotypes. The 2-sinus BAV has 2 cusps, roughly equal in size and shape, each cusp occupying 180° of the annular circumference, with only 2 aortic sinuses, resulting in a 2-sinus/2-cusp valve without raphe and with 180° commissural angles. Since the elliptic aortic annulus in BAV patients poses a challenge for sutureless valves and the RAT approach has been increasingly adopted for minimally invasive SAVR, our description of the surgical technique focuses on the specific procedural details in the scenario of 2-sinus BAV laterolateral phenotype.

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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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