No abstract

CABG (Coronary Artery Bypass Grafting) has been the treatment of choice for coronary artery disease for over 50 years and is the most common cardiac surgery procedure performed. Traditionally CABG was performed with the use of cardiopulmonary bypass and the use of cardioplegia to allow the surgeon to operate on a stable field. In the mid-1990s, interest emerged in performing CABG without the use of cardiopulmonary bypass - off pump CABG. This invited commentary focuses on sharing our experience with Low Ejection fraction off-pump CABG and why this approach could be beneficial to this patient population.

Objective: To describe experience with using intraoperative Transesophageal Echocardiography to reliably predict the size of the rapid deployment prosthetic valve by measuring the native aortic annulus Methods: Retrospective review of single institution series of patients undergoing Aortic Valve Replacement with Rapid Deployement Bioprosthetic Valves. Included were patients that had their native aortic valve replaced either isolated or as part of any additional procedure. Aortic annulus was measured prior to initiation of the operation using transesophageal echocardiography (TEE). Correlation analysis was conducted between Echocardiographic annular measurements and actual implanted valve sizes. Results: Twenty five patients underwent rapid deployment valve implantation in the aortic position. Of these, 36% of patients had the same size valve as the measured aortic annulus, 48% of patients had a valve implanted that was 1 mm different, and 16% of patients had 2 mm difference. The mean annular size based was 22.4 mm (range: 21-28 mm). The mean valve size implanted was 23.3 mm (range: 21-27 mm). There was no statistically significant difference between the mean annular measurement and the valve size selected (0.9 mm , p = 0.8). Conclusion: TEE can further enhance valve sizing and guidance through a proper and safe deployment. Although evident in our experience, larger scale studies are needed to further elucidate conclusions on the importance of avoiding under-sizing valves.

Sutureless/rapid deployment valves provide surgeons with a new tool for aortic valve replacement (AVR) therapy, which can simplify the procedure. A main concern being the development of a paravalvular leak. We retrospectively reviewed our Aortic Valve Replacement database, were able to identify 25 rapid deployment aortic valves (INTUITY Valve System, Edwards Life Sciences LLC, Irvine, Calif) that had documented intraoperative Transesophageal Echocardiographic Annular measurements. All valves were implanted in the Aortic position. In this cohort, only patients that had their native aortic valve replaced either isolated or as part of any additional procedure were included. Patients that underwent Intuity valve implantation for Redo Aortic valve replacement were excluded from this study. After review of 25 patients who underwent rapid deployment valve

Objective: To describe our experience with using intraoperative Transesophageal Echocardiography (TEE) to assess the size of the rapid deployment prosthetic valves by measuring the native aortic annulus. Methods: Retrospective review of single institution series of patients undergoing Aortic Valve Replacement with Rapid Deployment Bioprosthetic Valves. Included were patients who had their native aortic valve replaced either isolated or as part of any additional procedure. The aortic annulus was measured prior to initiation of the operation using TEE. An analysis was conducted between Echocardiographic annular measurements and actual implanted valve sizes. Results: Forty patients underwent rapid deployment valve implantation in the aortic position. Of these, 32.5% of patients had the same size valve as the measured aortic annulus, 40% of patients had a valve implanted that was 1 mm different, and 25% of patients had 2 mm difference. One patient (2.5%) was found to have an aortic annular measurement of 3mm less than the actual implanted valve. The mean annular size based on intraoperative TEE was 23.5 mm (range: 21-28 mm, sdv: 1.8). The mean valve size implanted was 23.7 mm (range: 21-27 mm, sdv: 1.9). There was no statistically significant difference between the mean annular measurement and the valve size selected (0.2 mm, p = 0.50). Conclusion: TEE can further enhance valve sizing and guidance through a proper and safe deployment. Although evident in our experience, larger scale studies are needed to further elucidate conclusions on the importance of avoiding under-sizing valves.