Aortic Root Surgery: The Biological Solution by Charles Abraham Yankah, Yu-Guo Weng, Roland Hetzer

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By Charles Abraham Yankah, Yu-Guo Weng, Roland Hetzer

The surgical result of bioprosthetic aortic valve substitute within the Nineteen Sixties and Nineteen Seventies weren't very passable. the quest for the correct replacement for the diseased aortic valve led Donald Ross to strengthen the idea that of the aortic allograft in 1962 and the pulmonary autograft in 1967 for subcoronary implantation, and later, in 1972, as a whole root for exchanging the aortic root within the contaminated aortic valve with a root abscess. The aortic al- graft and pulmonary autograft surgeries have been revo- tionary within the historical past of cardiac valve surgical procedure within the final m- lennium simply because they compete good with the bioprosthesis, are nonthrombogenic (thus, requiring no postoperative anticoa- lation), are immune to an infection, repair the anatomic devices of the aortic or pulmonary outflow tract, and provide unimpeded blood stream and perfect hemodynamics, giving sufferers a b- ter diagnosis and caliber of lifestyles. surgical procedure for congenital, degenerative, and inflammatory aortic valve and root ailments has now reached a excessive point of adulthood; but an excellent valve for valve substitute isn't really to be had. The- fore, surgeons are focusing their abilities and their scientific and s- entific wisdom on optimizing the technical artistry of val- sparing tactics.

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Circulation 116(Suppl I):I240–I245 9. Walther T, Dewey T, Borger M, Kempfert J, Linke A, Becht R, Falk V, Schuler G, Mohr F, Mack M (2008) Human minimally invasive off-pump valve-in-valve implantation: Step by step. Ann Thorac Surg 85:1072–1073 10. Grube E, Schuler G, Blumenthal L et al (2007) Percutaneous aortic valve replacement for severe aortic stenosis in high risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome.

Grube E, Gerckens U (2008) Retrograde transfemoral aortic valve replacement – from early device prototypes to a routine cath lab procedure. Data on CoreValve registry presented at TCT, Washington, 12th–17th October 2008 20. Dawkins S, Hobson AR, Kalra PR, Tang AT, Monro JL, Dawkins KD (2008) Permanent pacemaker implantation after isolated aortic valve replacement: incidence, indications, and predictors. The Annals of thoracic surgery 85(1):108–112 21. Koplan BA, Stevenson WG, Epstein LM, Aranki SF, Maisel WH (2003) Development and validation of a simple risk score to predict the need for permanent pacing after cardiac valve surgery.

Transapical aortic valve implantation – a truly minimally invasive option for high-risk patients z Fig. 3. Femoral “safety net”: percutaneous venous wire and arterial 6F sheath z Sizing and valve preparation After repeat measurements of the aortic annulus by TEE (strictly perpendicular long axis view), the size of the transcatheter valve is selected to ensure adequate oversizing of at least 2 mm. The valve is then prepared and crimped on a balloon delivery catheter under sterile conditions in the operating room by a technician just prior to implantation.

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