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

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

The surgical result of bioprosthetic aortic valve substitute within the Sixties and Seventies weren't very passable. the hunt for the precise alternative for the diseased aortic valve led Donald Ross to increase the concept 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 changing 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 heritage 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 proof against an infection, fix the anatomic devices of the aortic or pulmonary outflow tract, and provide unimpeded blood circulation and ideal hemodynamics, giving sufferers a b- ter diagnosis and caliber of existence. surgical procedure for congenital, degenerative, and inflammatory aortic valve and root ailments has now reached a excessive point of adulthood; but a fantastic valve for valve alternative isn't really on hand. 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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Extra resources for Aortic Root Surgery: The Biological Solution

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Naturally these elderly patients often present with significant comorbidities resulting in an increased operative risk profile. Even in presence of an increased risk profile, aortic valve replacement can be performed in elderly patients with an acceptable clinical outcome leading to a significant improvement in the individual’s quality of life [3]. According to the literature 30-day mortality after conventional aortic valve replacement in octogenarians is around 5–10% [4, 5], which is acceptable when taking into account the grave prognosis of elderly patients suffering from severe symptomatic aortic stenosis with mortality rates of up to 50% within the next year without surgical intervention [6].

Therefore, patients should be kept on a monitor (or telemetric surveillance) for at least 5 d. Indication for permanent pacemaker implantation should be handled liberally. Full anticoagulation is not required in case of stable sinus rhythm. Low dose aspirin and prophylactic low molecular heparin are sufficient. Transapical aortic valve implantation – a truly minimally invasive option for high-risk patients z Current results After initial pioneering in the field of transcatheter valve therapy, transapical (TA) and transfemoral (TF) aortic valve implantation (AVI) have evolved to an almost routine procedure in specialized centers.

The left anterolateral minithoracotomy should result in straight access to the left ventricular apex. After opening the pericardium longitudinally, four pericardial stay sutures are placed to expose the apex and to allow for bilateral lung ventilation. An epicardial bipolar pacing wire is placed and tested. Two apical purse-string sutures (Prolene 2–0, large (MH) needle with 5 interrupted Teflon pledgets) are placed lateral to the LAD with sufficiently deep bites (approximately 3–5 mm, not penetrating completely) in the myocardium (Fig.

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