Use of stentless xenografts in the aortic position: determinants of early and late outcome

Akar, Ahmet; Szafranek, Adam; Alexiou, Christos; Janas, R; Jasiński, Marek; Swanevelder, Justiaan; Sosnowski, Andrzej

doi:10.1016/s0003-4975(02)03845-6

Cited by 30 publications

(16 citation statements)

References 23 publications

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“…Medtronic Freestyle bioprosthesis has many advantages over traditional bioprosthesis; hemodynamic compatibility, laminar flow pattern, resistance to calcification, and durability. [4] No problem was noted during the follow up period of our patients. An ideal stentless aortic valve for a person is own pulmonary valve.…”

Section: Discussionmentioning

confidence: 55%

Medtronic Freestyle Aortic Root Bioprosthesis Implantation for the Infective Endocarditis on Aortic Root

Arslan¹

2014

Ann Clin Anal Med

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Section: Discussionmentioning

confidence: 55%

Medtronic Freestyle Aortic Root Bioprosthesis Implantation for the Infective Endocarditis on Aortic Root

Arslan¹

2014

Ann Clin Anal Med

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“…(33) These prostheses require surgical experience and accurate intra-operative TOE analysis such as precise diameter measurements of the aortic root and ascending aorta as well as the origin of the coronary ostia. (58,59) Discrepancy between measurements due to dilatation of the ascending aorta may lead to tethering and splaying of the stentless prosthetic leaflets after implantation, which may result in AR. Considering these variations in PERI-OPERATIVE TOE FIgurE 3b: During repair the surgeon commented on the extreme calcification of the annulus.…”

Section: Peri-operative Toementioning

confidence: 99%

The role of peri-operative transoesophageal echocardiography

Swanevelder

2017

SAHJ

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The role of peri-operative transoesophageal echocardiography cardiovascular surgery. (5,6,7,8,9,10) More recent retrospective analyses of prospectively collected data suggest that around 5.6% of surgical procedures are altered on the basis of intra-operative echocardiographic findings and that there are cost-benefit savings particularly during combined valve and graft operations. (11,12,13) Recently, the roles for peri-operative echocardiography have also extended to include intensive care (14,15) and non-cardiac surgery. (16,17,18) Although it is complex to scientifically prove the benefits of a diagnostic monitor, TOE has been shown to strongly influence intra-operative anaesthetic decisions, particularly in patients with increased risk factors for haemodynamic instability or myocardial ischaemia. In a prospective observational case series of 98 patients undergoing abdominal surgery, the judgement of the anaesthetists was that TOE led to useful alterations in intraoperative care such as administration of fluids, vasoactive drugs and β blockers. In some patients, use of the pulmonary artery catheter was obviated. (19) Similarly, in another case series comprising 90 patients undergoing vascular, visceral and chest surgery, TOE directed changes in drug (47%) and fluid therapy (24%). PERI-OPERATIVE TOE IntroductIonIn 1976 transoesophageal echocardiography (TOE) was introduced into clinical practice.(1) Within a decade, its use extended from cardiology departments into the cardiac surgical arena. However,at that time few probes were available for the operating theatre.Indeed in a report from the United States in 1988, only about 50 TOE probes were accessible for intra-operative use.(2) Furthermore, despite its utility for cardiac surgery, it became evident that few cardiologists were able to spend long periods in the operating theatre. Over time much enthusiasm and expertise for TOE has developed amongst cardiac anaesthesiologists, and by 2001, 94%of respondents in a survey of the Society of CardiovascularAnaesthesiologists utilised intra-operative echocardiography in their routine practice.Over the past 30 years technology has improved tremendously and intra-operative TOE has become an established imaging modality and the gold standard intra-operative cardiac monitor and diagnostic tool in certain cardiac procedures, e.g. mitral valve repair, congenital heart surgery, etc. IndIcAtIons And PrActIcE guIdElInEsEarly experience with the use of peri-operative echocardiography was obtained from its application in cardiac anaesthetic practice; recently however, its role has extended to include non-cardiac surgery and intensive care. Category I indications are supported by strong evidence and expert opinion that TOE is indicated, very useful and will improve patient outcome. These category I indications encompass the everyday practice of the intra-operative anaesthetist-echocardiographer and will be discussed in more detail in this review.Category II indications are supported by weaker evidence and less expert opinion ...

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“…Routines reduce chances of infectious colonization and thrombus formation, but they do little to contribute to the preservation of structural aspects. These must be worked by means of optimistic outlooks in research labs which, in relation to bioprostheses, currently include improvement of the annulus (stentless or less-stented) [20][21][22] to favor hemodynamics, and technologies that cause decellularization to favor tissue preservation by preventing inflammatory reactions 23,24 .…”

Section: Establishing Prosthesis-dependencementioning

confidence: 99%

“…The subsequent steps were reinforced by convictions nourished by the medical-social realities of its population and users. The ongoing routine is sustained by the reasonability of the degree of beneficence/nonharmfulness observed in analyses of morbidity and survival [20][21][22] , taking into account evidence of good quality of life in the period of time elapsing between the implant and reoperation -this latter being undoubtedly the Achilles heel of opting for a bioprosthesis.…”

Section: Establishing Prosthesis-dependencementioning

confidence: 99%