Aortic Valve Bypass Surgery

Gammie, James S.; Krowsoski, Leandra; Brown, James M.; Odonkor, Patrick; Young, Cindi A.; Santos, Mary J.; Gottdiener, John S.; Griffith, Bartley P.

doi:10.1161/circulationaha.108.790030

Cited by 70 publications

(9 citation statements)

References 35 publications

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“…91 Another option to avoid aortic cross-clamping and manipulation in patients with severe AS is the apico-aortic conduit technique. 92,93 It is an aortic valve bypass surgery that uses a conduit containing a prosthetic valve that relieves AS by shunting blood from the apex of the left ventricle to the descending thoracic aorta. The disadvantages of this technique include the necessity for a sizable left thoracotomy, the fact that it is feasible only if no significant aortic regurgitation is present, and the challenge of performing an anastomosis of the conduit to the descending aorta in case of a concomitant calcified descending aorta, which is usually present.…”

Section: Pa and Cardiac Surgerymentioning

confidence: 99%

Porcelain Aorta

et al. 2015

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Section: Pa and Cardiac Surgerymentioning

confidence: 99%

Porcelain Aorta

et al. 2015

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“…La mortalidad perioperatoria fue de un 13%, aunque en los últimos 16 pacientes, no hubo mortalidad. En todos los casos y a diferencia de las experiencias previas, el abordaje se hizo a través de una toracotomía posterolateral izquierda y la anastomosis distal se realizó en la aorta descendente 11 . El abordaje transtorácico es muy bien tolerado por los pacientes, ofrece un acceso directo a la aorta torácica descendente y se evita una nueva esternotomía.…”

Section: Discussionunclassified

Implante De Conducto Apicoaórtico en Paciente Con Estenosis Aórtica Severa Post Reemplazo Valvular Protésico

A¹,

S²,

Silva-Júnior³

et al. 2014

Rev Chil Cir

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Apicoaortic valved conduit implanted in a patient with severe aortic stenosis due to mismatched aortic valve prosthesis Introduction: The most frequent surgical procedure of severe left ventricular outflow tract obstruction due to severe aortic stenosis is aortic valve replacement, but there is an alternative and less conventional method described by Cooley used in patients with previous aortic valve replacement and severe aortic wall calcification that bypasses the left ventricular outflow tract through the implant of an apicoaortic valved conduit. Clinical case: We describe the case of 42 years old patient with severe aortic stenosis due to mismatched valve prosthesis previously installed treated by of apicoaortic conduit implanted through left posterolateral thoracotomy.

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“…1 AVB surgery was first reported in animal models in 1955, but the first successful clinical case was done in 1962. Although it was subsequently eclipsed by conventional AVR, the continued improvements in technology and surgical technique have contributed to its…”

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Transcatheter Aortic Valve Replacement as a Treatment for Late Apicoaortic Conduit Obstruction in a Patient With Severe Aortic Stenosis

et al. 2013

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A 62-year-old man presented with progressive exertional dyspnea and angina. His past medical history is notable for coronary artery disease, for which he underwent a coronary artery bypass graft surgery 8 years earlier. A few years afterward, he underwent aortic valve (AV) bypass (AVB) surgery for severe aortic stenosis (AS) using an apicoaortic conduit to the descending aorta consisting of a 16-mm connector and an 18-mm valved conduit (Hancock valve; Medtronic, Minneapolis, MN; Figures 1 and 2; onlineonly Data Supplement Movie I). After a period of initial improvement in symptoms, the patient developed progressive dyspnea and angina and was referred for additional cardiac workup.The patient underwent a bicycle ergometer test, which showed a diminished functional capacity and was stopped because of fatigue and a hypotensive response. He underwent a 2-dimensional transthoracic echocardiogram with gradual dobutamine infusion. He was found to have a heavily calcified AV (online-only Data Supplement Movie II) with a rest mean transvalvular gradient of 34 mm Hg and velocity of 3.5 m/s, which increased to 50 mm Hg and 4.8 m/s, respectively, at peak dobutamine dose (Figure 3). This corresponded with a flow increase across the native AV from 1.7 to 4.3 L/min. A minimal mean gradient of 2 mm Hg was detected at the apicoaortic conduit proximal limb at the anastomosis of the left ventricular (LV) apex and conduit, which increased to 3.4 mm Hg at peak dobutamine (Figures 3) and corresponded with a flow increase across the conduit from 2.3 to 4.7 L/min. A left heart and apicoaortic conduit catheterization were performed (Figure 4; online-only Data Supplement Movies III and IV). A mean gradient of 38 mm Hg across the heavily calcified native AV was detected using a double-lumen catheter. On selective catheterization of the distal portion of the apicoaortic conduit (distal to the prosthetic Hancock AV inside the conduit) using an end-hole catheter, a gradient between the LV and distal limb of the apicoaortic conduit of 12 mm Hg was evident. A slow pullback of the end-hole catheter from the distal limb of the apicoaortic conduit into the aorta, with intermittent contrast angiography, showed an 80% narrowing at the conduitaorta anastomosis, and a 40-mm Hg gradient between the distal limb of the apicoaortic conduit and the aorta at the anastomosis site ( Figure 5; online-only Data Supplement Movie V). An ECG-gated contrast-enhanced computed tomography scan showed heavy AV calcification and an aortic annulus area of 489 mm 2 . The apicoaortic conduit was noted from the LV apex to the descending aorta, with severe narrowing at the distal anastomotic site (Figure 6). The patient's calculated STS score put him at 9.4% mortality risk and 38.6% risk of morbidity or mortality for redo AVR. After deliberations by our multidisciplinary heart team, he underwent a successful transfemoral transcatheter AV replacement (TAVR) using an Edwards Sapien 26-mm valve (Edwards Lifesciences LLC, Irvine, CA; online-only Data Supplement Movies VI and V...

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Aortic Valve Bypass Surgery

Cited by 70 publications

References 35 publications

Porcelain Aorta

Porcelain Aorta

Implante De Conducto Apicoaórtico en Paciente Con Estenosis Aórtica Severa Post Reemplazo Valvular Protésico

Transcatheter Aortic Valve Replacement as a Treatment for Late Apicoaortic Conduit Obstruction in a Patient With Severe Aortic Stenosis

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