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Transapical aortic valve implantation: step by step


Walther, T; Dewey, T; Borger, M A; Kempfert, J; Linke, A; Becht, R; Falk, V; Schuler, G; Mohr, F W; Mack, M (2009). Transapical aortic valve implantation: step by step. Annals of Thoracic Surgery, 87(1):276-283.

Abstract

PURPOSE: Transapical aortic valve implantation is a new minimally invasive technique for beating heart, off-pump, aortic valve implantation in high-risk patients. DESCRIPTION: The procedure involves antegrade aortic valve implantation using an oversizing technique with direct access and accurate positioning of a stent-based transcatheter xenograft. Procedural steps include placement of femoral arterial and venous access wires, anterolateral mini-thoracotomy, epicardial pacing, and apical pursestring suture placement. Valve positioning is performed under fluoroscopic and echocardiographic guidance during rapid ventricular pacing. EVALUATION: Patient screening, especially regarding native aortic annulus diameter and pattern of calcification, is essential for success. Since imaging is crucial, implantations are optimally performed in a hybrid operative theater by an experienced team of cardiac surgeons, cardiologists, and anesthetists. CONCLUSIONS: The aim of this article is to outline the technical aspects of the new technique of minimally invasive transapical aortic valve implantation.

Abstract

PURPOSE: Transapical aortic valve implantation is a new minimally invasive technique for beating heart, off-pump, aortic valve implantation in high-risk patients. DESCRIPTION: The procedure involves antegrade aortic valve implantation using an oversizing technique with direct access and accurate positioning of a stent-based transcatheter xenograft. Procedural steps include placement of femoral arterial and venous access wires, anterolateral mini-thoracotomy, epicardial pacing, and apical pursestring suture placement. Valve positioning is performed under fluoroscopic and echocardiographic guidance during rapid ventricular pacing. EVALUATION: Patient screening, especially regarding native aortic annulus diameter and pattern of calcification, is essential for success. Since imaging is crucial, implantations are optimally performed in a hybrid operative theater by an experienced team of cardiac surgeons, cardiologists, and anesthetists. CONCLUSIONS: The aim of this article is to outline the technical aspects of the new technique of minimally invasive transapical aortic valve implantation.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:01 Apr 2009 18:52
Last Modified:05 Apr 2016 13:11
Publisher:Elsevier
ISSN:0003-4975
Publisher DOI:https://doi.org/10.1016/j.athoracsur.2008.08.017
PubMed ID:19101311

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