Name: technique and patient selection criteria of right anterior mini-thoracotomy for minimal access aortic valve replacement
Uploaded: 2018-03-26T15:00:00.000+00:00
Duration: 8 min 50 s
Description: Watch this Scientific Journal Video about Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement at JoVE.com

这项工作得到了瑞士心血管基金会的赠款 (N° 32119) 的支持。

该议定书遵循了人类研究伦理学委员会的机构准则。
1. 患者选择 (表 1)
<ol><li>确定有必要隔离主动脉瓣置换的患者14。</li>
	<li>在这些患者中选择一个没有主要的胸畸形 (Kypho 脊柱侧凸) 的亚组, 以前的放疗史或右半胸腔手术, 需要紧急手术, 并手术治疗活动性心内膜炎。</li>
	<li>进行胸部计算机断层扫描 (CT) 检查, 以排除患者的升主动脉动脉瘤≥4.5 厘米。</li>
	<li>根据胸部 CT (图 1和2和表 1) 提供的测量结果作出最终决定。选择在第二或第三肋间空间, 根据更接近的距离主动脉插管点和主动脉环。</li>
</ol>2. 手术准备
<ol><li>按照以前描述的14, 为成人心脏手术患者的机构指南和建议准备手术病人。</li>
	<li>把外部除颤器垫放在背部和左胸前方前的悬垂。</li>
</ol>3. 手术
<ol><li>通过右前小切口进入心脏<ol>
<li>切割皮肤横向超过8厘米与18刀片刀在选择肋间空间, 开始1厘米右侧的胸骨边缘。</li>
		<li>用烙切开胸和肋间肌肉的表面层。为避免右肺损伤, 先用 Metzenbaum 剪刀进入右胸膜。然后用烙扩大肋间肌的开口。</li>
		<li>保留右内胸椎椎弓根通过释放它的筋膜和软组织周围使用 Metzenbaum 剪刀。</li>
		<li>将软组织牵引器插入右胸膜, 并将其固定在伤口上。注意不要伤害右内胸蒂。</li>
		<li>将最小的接入牵引器放在软组织牵引器上, 轻轻地慢慢地打开。</li>
		<li>用 Carpentier 钳抓住 cranially 上覆的脂肪, 用烙切开。注意不要伤害右膈神经。</li>
		<li>打开右心房的心包与烙和地方 2/0 polyglactin 留缝线两侧的开放, 以传播心包。</li>
		<li>继续打开心包 cranially 在上升主动脉和 caudally 在右心房。放置 2/0 polyglactin 留缝线两侧的开口, 传播心包。</li>
		<li>检查远端心包反射线上方的上升主动脉和主动脉根部的基础, 准备放置的主动脉插管钱包字符串。</li>
		<li>验证右上肺静脉的解剖位置, 以放置左心室通气孔。</li>
		<li>为了暴露出上升主动脉的远端, 用阿利斯钳上的花生纱布轻轻推下上升的主动脉。</li>
		<li>将第一个钱包字符串放置在远端心包反射线下方的主动脉插管上, 使用4/0 聚丙烯缝合。完成主动脉插管的准备, 通过添加第二个钱包字符串围绕第一个使用4/0 聚丙烯缝合。</li>
		<li>给300国际单位肝素/千克 (浓度 5000 U/毫升) 通过 IV 线。</li>
	</ol></li>
	<li>将病人连接到体外循环<ol>
<li>首先穿刺右股静脉, 并将导丝通过针进入静脉。用11刃刀扩大皮肤开口。扩大穿刺部位的连续扩张器, 并介绍经皮股骨静脉套管在导丝下经食管超声心动图控制 (图表 3)。</li>
		<li>用阿利斯钳上的花生纱布轻轻推下提升主动脉, 在钱包的中间刺入上升的主动脉。Cannulate 在导丝上的主动脉。</li>
		<li>启动心肺旁路, 使病人降温至30摄氏度 (图 4)。为改善静脉回流, 让 perfusionnist 应用辅助负压-50 mmHG。</li>
		<li>轻轻推上上腔静脉向左侧, 并放置一个钱包字符串在右上肺静脉与4/0 聚丙烯单丝缝合。插入左心室通气通过钱包字符串卸载左心。</li>
	</ol></li>
	<li>准备阀门的切除和更换<ol>
<li>使用具有可伸缩刚性轴的挠性夹具, 在主动脉套管下方交叉夹住升主动脉。</li>
		<li>执行倒置 L aortotomy 平行和在水平的中管交界, 延伸到非冠状动脉佛氏窦。用阿利斯钳收回 aortotomy 的下脊。</li>
		<li>在主动脉返流的情况下, 将顺晶体停搏液直接送到冠状动脉内。</li>
		<li>将 aortotomy 通过非冠状动脉窦延伸至1厘米以上的主动脉环。检查左、右冠状动脉的提亚。</li>
		<li>将5/0 聚丙烯缝合在 aortotomy 的下脊上, 并将其表面固定在右心室的前部, 以改善主动脉瓣的暴露。</li>
		<li>在 aortotomy 的上脊上再放置5/0 聚丙烯缝合线, 并将其表面固定在心包上, 以改善主动脉瓣的暴露。</li>
		<li>抓取右, 非冠状动脉, 左冠状动脉尖带内钳和使用内剪。通过 aortotomy 检查二尖瓣。</li>
		<li>使用商用阀门 sizers 确定要插入的阀门的标签尺寸。选择一个舒适通过主动脉室连接的粒。</li>
		<li>将第一个编织聚酯2/0 与 pledget U 缝合在合生面之间的左和右冠状动脉窦, 使用一个内针持有人。通过从心室的缝合, 使 pledget 在心室一侧。</li>
		<li>继续放置编织聚酯2/0 与 pledget U 缝线顺时针, 以完成右冠状动脉窦。</li>
		<li>将顺时针编织聚酯2/0 与 pledget U 缝合在非冠状动脉窦。</li>
		<li>通过放置逆时针编织聚酯2/0 与 pledget U 缝合在左冠状动脉窦, 开始在合生面之间的右, 左冠状动脉鼻窦, 完成环缝缝合。</li>
		<li>使用莱德针固定器将编织聚酯2/0 缝线传递到阀门假肢的缝纫环上。</li>
		<li>滑下阀门假肢, 卸下阀座。系上缝合线, 检查它们与主动脉环的间隙。验证左、右冠状动脉的提亚是通畅的。</li>
		<li>用 Metzenbaum 剪刀剪下绑缝线。去除 aortotomy 上脊的5/0 外露缝线。</li>
		<li>关闭 aortotomy 由两个5/0 聚丙烯运行半缝合。将第一个放在非冠状动脉窦 aortotomy 的最低点, 并系上它。然后来到倒 aortotomy 的角度。把缝合的末端放在轻微的张力下。</li>
		<li>继续关闭的 aortotomy 由第二5/0 聚丙烯运行半缝合从左端开始, 并朝右侧, 以满足第一个半缝合的结束。把两头绑在一起, 切掉它们。</li>
		<li>在松开主动脉前, 将心室起搏导线放在右心室。</li>
		<li>让工作台倾斜在向健位置。将泵流量减少到50% 的全流量。在左心室通气口的温柔吸入下, 慢慢移除主动脉交叉钳14。</li>
		<li>恢复全流程的心肺旁路。检查 aortotomy 闭合的止血情况。取出左心室通气孔并系上它的钱包绳。检查止血。</li>
		<li>复温病人到37摄氏度。将病人与心肺旁路分离。当达到稳定的血压时, 在1:1 的比例 (3 毫克/千克对应于300的肝素)14中, 用精蛋白注入 IV 中和肝素。</li>
		<li>准备通过捆绑第一个钱包字符串来去除主动脉插管。让助手轻轻地移除主动脉插管, 并完成捆绑的钱包字符串。</li>
		<li>双安全的主动脉插管部位与一个数字八4/0 聚丙烯缝合。割断缝合线</li>
		<li>取出股静脉插管, 用人工压迫止血20分钟。</li>
		<li>放置一个心包和一个右胸导管。调整心包与三松散捆绑编织 2/0 polyglactin 缝合。</li>
		<li>用两条编织 0 polyglactin 缝线调整肋骨。以标准的方式关闭伤口。</li>
	</ol></li>
</ol>4. 术后病人护理
<ol><li>在转移到重症监护病房后, 为患者提供心脏外科手术的标准术后护理14。</li>
</ol>

<ol>
	<li>Supino, P. G., Borer, J. S., Preibisz, J., Bornstein, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+epidemiology+of+valvular+heart+disease:+a+growing+public+health+problem.">The epidemiology of valvular heart disease: a growing public health problem.</a> Heart. Fail. Clin. 2 (4), 379-393 (2006).</li><li>Carabello, B. A., Paulus, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aortic+stenosis.">Aortic stenosis.</a> The Lancet. 373 (9667), 956-966 (2009).</li><li>Bonow, R. O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Focused+update+incorporated+into+the+ACC/AHA+2006+guidelines+for+the+management+of+patients+with+valvular+heart+disease.">Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease.</a> Circulation. 118 (15), 523-661 (2008).</li><li>Brown, J. M., O'Brien, S. M., Wu, C., Sikora, J. A. H., Griffith, B. P., Gammie, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolated+aortic+valve+replacement+in+North+America+comprising+108,687+patients+in+10+years:+changes+in+risks,+valve+types,+and+outcomes+in+the+Society+of+Thoracic+Surgeons+National+Database.">Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database.</a> J. Thorac. Cardiovasc. Surg. 137 (1), 82-90 (2009).</li><li>Cribier, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+transcatheter+implantation+of+an+aortic+valve+prosthesis+for+calcific+aortic+stenosis.+First+human+case+description.">Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis. First human case description.</a> Circulation. 106 (24), 3006-3008 (2002).</li><li>Leon, M. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+aortic-valve+implantation+for+aortic+stenosis+in+patients+who+cannot+undergo+surgery.">Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.</a> N. Engl. J. Med. 363 (17), 1597-1607 (2010).</li><li>Popma, J. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+aortic+valve+replacement+using+a+self-expanding+bioprosthesis+in+patients+with+severe+aortic+stenosis+at+extreme+risk+for+surgery.">Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery.</a> J. Am. Coll. Cardiol. 63 (19), 1972-1981 (2014).</li><li>Smith, C. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+versus+surgical+aortic-valve+replacement+in+high-risk+patients.">Transcatheter versus surgical aortic-valve replacement in high-risk patients.</a> N. Engl. J. Med. 364 (23), 2187-2198 (2011).</li><li>Adams, D. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+aortic-valve+replacement+with+a+self-expanding+prosthesis.">Transcatheter aortic-valve replacement with a self-expanding prosthesis.</a> N. Engl. J. Med. 370 (19), 1790-1798 (2014).</li><li>Glauber, M., Ferrarini, M., Miceli, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+aortic+valve+surgery:+state+of+the+art+and+future+directions.">Minimally invasive aortic valve surgery: state of the art and future directions.</a> Ann. Cardiothorac. Surg. 4 (1), 26-32 (2015).</li><li>Malaisrie, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+era+minimally+invasive+aortic+valve+replacement:+techniques+and+practice.">Current era minimally invasive aortic valve replacement: techniques and practice.</a> J. Thorac. Cardiovasc. Surg. 147 (1), 6-14 (2014).</li><li>Benetti, F. J., Mariani, M. A., Rizzardi, J. L., Benetti, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+aortic+valve+replacement.">Minimally invasive aortic valve replacement.</a> J. Thorac. Cardiovasc. Surg. 113 (4), 806-807 (1997).</li><li>Murtuza, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimal+access+aortic+valve+replacement:+is+it+worth+it.">Minimal access aortic valve replacement: is it worth it.</a> Ann. Thorac. Surg. 85 (3), 1121-1131 (2008).</li><li>Tavakoli, R., Jamshidi, P., Gassmann, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Full-root+aortic+valve+replacement+by+stentless+aortic+xenografts+in+patients+with+small+aortic.">Full-root aortic valve replacement by stentless aortic xenografts in patients with small aortic.</a> J. Vis. Exp. (123), (2017).</li><li>Roques, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=LRisk+factors+and+outcome+in+european+cardiac+surgery:+analysis+of+the+EuroSCORE+multinational+database+of+19030+patients.">LRisk factors and outcome in european cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients.</a> Eur. J. Cardiothorac. Surg. 15 (6), 816-823 (1999).</li><li>Bowdish, M. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+aortic+valve+replacement+via+an+anterior+right+minithoracotomy+with+standard+sternotomy:+a+propensity+score+analysis+of+492+patients.">A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy: a propensity score analysis of 492 patients.</a> Eur. J. Cardiothorac. Surg. 49 (2), 456-463 (2016).</li><li>Bethencourt, D. M., Le, J., Rodriguez, G., Kalayjian, R. W., Thomas, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+aortic+valve+replacement+via+right+anterior+minithoracotomy+and+central+aortic+cannulation:+A+13-Year+experience.">Minimally invasive aortic valve replacement via right anterior minithoracotomy and central aortic cannulation: A 13-Year experience.</a> Innovations (Phila). 12 (2), 87-94 (2017).</li><li>Lamelas, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+aortic+valve+replacement:+the+"Miami+Method".">Minimally invasive aortic valve replacement: the "Miami Method".</a> Ann Cardiothorac. Surg. 4 (1), 71-77 (2015).</li><li>Murzi, M., Glauber, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Central+versus+femoral+cannulation+during+minimally+invasive+aortic+valve+replacement.">Central versus femoral cannulation during minimally invasive aortic valve replacement.</a> Ann. Cardiothorac. Surg. 4 (1), 59-61 (2015).</li><li>Grossi, E. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evolution+of+operative+techniques+and+perfusion+strategies+for+minimally+invasive+mitral+valve+repair.">Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair.</a> J. Thorac. Cardiovasc. Surg. 143 (4), 68-70 (2012).</li><li>LaPietra, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+cerebrovascular+accidents+in+patients+undergoing+minimally+invasive+valve+surgery.">Incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery.</a> J. Thorac. Cardiovasc. Surg. 148 (1), 156-160 (2014).</li><li>Gammie, J. S., Zhao, Y., Peterson, E. D., O'Brien, S. M., Rankin, J. S., Griffith, B. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Less-invasive+mitral+valve+operations:+trends+and+outcomes+from+the+Society+of+Thoracic+Surgeons+Adult+Cardiac+Surgery+database.">Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery database.</a> Ann Thorac Surg. 90 (5), 1408-1410 (2010).</li><li>Grossi, E. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+valve+surgery+with+antegrade+perfusion+strategy+is+not+associated+with+increased+neurological+complications.">Minimally invasive valve surgery with antegrade perfusion strategy is not associated with increased neurological complications.</a> Ann. Thorac. Surg. 92 (4), 1346-1350 (2011).</li><li>Murzi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Antegrade+and+retrograde+arterial+perfusion+strategy+in+minimally+invasive+mitral-valve+surgery:+a+propensity+score+analysis+on+1280+patients.">Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral-valve surgery: a propensity score analysis on 1280 patients.</a> Eur. J. Cardiothorac. Surg. 43 (6), 167-172 (2013).</li><li>Glauber, M., Farneti, A., Solinas, M., Karimov, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aortic+valve+replacement+through+a+right+minithoracotomy.">Aortic valve replacement through a right minithoracotomy.</a> Multimed. Man. Cardiothorac. Surg. 2006 (1110), (2006).</li><li>D'Agostino, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Society+of+Thoracic+Surgeons+Adult+Cardiac+Surgery+Database:+2016+Update+on+Outcomes+and+Quality.">The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality.</a> Ann. Thorac. Surg. 101 (1), 24-32 (2016).</li><li>Glauber, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Right+anterior+minithoracotomy+versus+conventional+aortic+valve+replacement:+A+propensity+score+matched+study.">Right anterior minithoracotomy versus conventional aortic valve replacement: A propensity score matched study.</a> J. Thorac. Cardiovasc. Surg. 145 (5), 1222-1226 (2013).</li><li>Jones, D. A., Tch&#233;tch&#233;, D., Forrest, J., Hellig, F., Lansky, A., Moat, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+SURTAVI+study:+TAVI+for+patients+with+intermediate+risk.">The SURTAVI study: TAVI for patients with intermediate risk.</a> EuroIntervention. 13 (5), 617-620 (2017).</li></ol>

作者没有什么可透露的。

在本协议中, 我们详细描述了右前小切口在孤立主动脉瓣置换术中的技术, 并着重介绍了该手术患者的选择标准。至于其他治疗干预, 正确的病人选择是成功完成手术的关键。本协议对患者的最佳 CT 测量方法进行了准确的描述, 并根据经验, 考虑了硝博士和同事在该领域的广泛工作10。这些最佳的 CT 测量增加了一些有价值的标准,即, 从主动脉环中的冠状动脉开口的距离, 到硝...

在心脏瓣膜病变诊断为血流动力学相关和临床上特别注意, 主动脉瓣狭窄是最常见的瓣膜病理学在美国和发达国家1, 2.在心血管健康研究中, 2% 的患者有坦率的主动脉狭窄, 随着年龄的增长明显增加: 1.3% 岁65-75 岁的患者, 2.4% 岁以上75-85 岁的患者, 4% 岁以上的病人中, 只有85年以上1。对于出现严重主动脉瓣狭窄的症状患者, 主动脉瓣置换术是美国心脏瓣膜病患者管理协会指导方针中的一项建议3。
常规手术主动脉瓣置换通过中位全胸骨 (FS) 已确立为治疗主动脉瓣狭窄的金标准, 并在发病率和死亡率方面取得了优异的结果4。这些结果鼓励将治疗适应症扩大到老年患者和高危患者。在这些患者亚群中已经实施了许多治疗策略, 以维持常规外科主动脉瓣膜置换术在普通人群中取得的良好效果。在这些替代治疗方式中, 经导管主动脉瓣植入 (TAVI) 于2002年由 Cribier 和同事5介绍。最初在垂死的病人, TAVI 迅速出现作为治疗的选择严重的主动脉狭窄谁不适合常规手术主动脉瓣替换6,7, 或作为一个较小的侵入性高危患者手术方法89。
尽管在选定的患者亚群中 TAVI 的结果有所改善, 许多症状性主动脉瓣狭窄患者仍然是手术主动脉瓣置换的候选者。在这些患者中, FS 主动脉瓣置换术是心脏外科医生最常用的方法。然而, 已开发出各种 "微创" 技术, 其基本原理是减少手术创伤10。所有这些最低限度的接入技术都旨在通过缩短住院率和潜在的节省全球成本来改善患者的舒适度, 减少手术后的疼痛, 加速患者的康复.10。在微创切口方法中, 上半胸骨 (UHS) 和右前小切口 (RAMT) 已成为文献11中报道的主要技术。右前小切口主动脉瓣置换术最初报告贝奈特家庭式et 等。12和上部半胸骨首先由几个作者11描述。除切口选择外, 目前采用两种动脉灌注策略: i) 外周股动脉插管, 比 ii.) 中央主动脉插管更为频繁。
尽管有报告说, 在微创主动脉瓣置换术后患者结局有了改善, 但对限制性手术和外周动脉灌注策略的缺点的担忧13导致许多心脏外科医生不让他们的病人受益于潜在的优势, 最小的访问方法的主动脉瓣置换。本协议的目的是详细描述这一技术的微创主动脉瓣置换通过右前小切口无肋骨切除/骨折, 并与中央主动脉插管动脉灌注。通过这项协议, 更多的心脏外科医生可以执行右前小切口主动脉瓣置换在某些病人组。讨论了患者的选择和技术的局限性。早期的结果与一组接受独立的主动脉瓣置换的患者进行比较, 完全胸骨。

<table><tbody><tr><td>&lt;strong&gt;Heart surgery infrastructure:&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Heart Lung Machine</td><td>Stockert</td><td>SIII</td><td></td></tr><tr><td>EOPA 24Fr. arterial cannula</td><td>Medtronic</td><td>77624</td><td></td></tr><tr><td>FemFlex arterial cannula</td><td>Edwards</td><td>FEMII20A</td><td></td></tr><tr><td>Quickdraw 25Fr. femoral venous cannula</td><td>Edwards</td><td>QD25</td><td></td></tr><tr><td>Biomedicus 25Fr. Nextgen venous cannula</td><td>Medtronic</td><td>96670-125</td><td></td></tr><tr><td>LV vent catheter 17Fr.</td><td>Edwards</td><td>E061</td><td></td></tr><tr><td>Antegrade 9Fr. cardioplegia cannula</td><td>Edwards</td><td>AR012V</td><td></td></tr><tr><td>Coronary artery ostial cannula 90&amp;deg;</td><td>Medtronic</td><td>30155</td><td></td></tr><tr><td>Coronary artery ostial cannula 45&amp;deg;</td><td>Medtronic</td><td>30255</td><td></td></tr><tr><td>&lt;strong&gt;Soft tissue retractor&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>STAR soft tissue atraumatic retractor</td><td>Estech</td><td>EC400220</td><td></td></tr><tr><td>Soft tissue retractor</td><td>Edwards</td><td>TRM</td><td></td></tr><tr><td>Electrocautery</td><td>Covidien</td><td>Force FX&lt;sup&gt;TM&lt;/sup&gt;</td><td></td></tr><tr><td>&lt;strong&gt;Sutures:&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Polypropylene 4/0</td><td>Ethicon</td><td>8871H</td><td></td></tr><tr><td>Polypropylene 5/0</td><td>Ethicon</td><td>8870H</td><td></td></tr><tr><td>Braided polyesther 2/0 ligature with polybutylate coating&amp;nbsp;</td><td>Ethicon</td><td>X305H</td><td></td></tr><tr><td>Braided polyesther2/0 with pledgets V5</td><td>Ethicon</td><td>MEH7715N</td><td></td></tr><tr><td>Braided polyglactin 2/0 suture</td><td>Ethicon</td><td>V114H</td><td></td></tr><tr><td>Braided polyglactin 0 suture</td><td>Ethicon</td><td>W9996</td><td></td></tr><tr><td>&lt;strong&gt;Drugs:&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Midazolam</td><td>Roche Pharma</td><td>N05CD08</td><td></td></tr><tr><td>Rocuronium</td><td>MSD Merck Sharp &amp;amp; Dohme&amp;nbsp;</td><td>M03AC09</td><td></td></tr><tr><td>Propofol</td><td>Fresenius Kabi</td><td>N01AX10</td><td></td></tr><tr><td>Fentanil</td><td>Actavis</td><td>N01AH01</td><td></td></tr><tr><td>Heparin</td><td>Braun</td><td>B01AB01</td><td></td></tr><tr><td>Protamin</td><td>MEDA Pharmaceutical</td><td>V03AB14</td><td></td></tr><tr><td>Custodiol cardioplegia solution</td><td>Dr. F. K&amp;ouml;hler Chemie GmbH</td><td>B05CX10</td><td></td></tr><tr><td>&lt;strong&gt;Instruments:&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Window access retractor SI</td><td>Estech</td><td>400-400</td><td></td></tr><tr><td>SI retractor blade 40W50L</td><td>Estech</td><td>400-172</td><td></td></tr><tr><td>Ceramo atraumatic forceps 2.8x15/350</td><td>Fehling</td><td>FE-MRA-3</td><td></td></tr><tr><td>Ceramo HCR valve forceps 3.0x15/350</td><td>Fehling</td><td>FE-MRA-0</td><td></td></tr><tr><td>Ceramo HCR needle holder 2x10/340</td><td>Fehling</td><td>FE-MRB-2</td><td></td></tr><tr><td>Ceramo TC HCR needle holder curved 3x10/340</td><td>Fehling</td><td>FE-MRG-9</td><td></td></tr><tr><td>Ceramo HCR valve scissors 350</td><td>Fehling</td><td>FE-MRA-7</td><td></td></tr><tr><td>Ceramo HCR curved scissors 350</td><td>Fehling</td><td>FE-MRA-6</td><td></td></tr><tr><td>Cygnet flexible arched aortic clamp</td><td>Vitalitec</td><td>V10143</td><td></td></tr><tr><td>Intrack insert set double traction</td><td>Vitalitec</td><td>N10122</td><td></td></tr><tr><td>Dissection forceps Carpentier</td><td>Delacroix-Chevalier</td><td>DC13110-28&amp;nbsp;</td><td></td></tr><tr><td>Scissors Metzenbaum</td><td>Delacroix-Chevalier</td><td>B351751</td><td></td></tr><tr><td>Needle holder Ryder</td><td>Delacroix-Chevalier</td><td>DC51130-20&amp;nbsp;</td><td></td></tr><tr><td>Dissection forceps DeBakey</td><td>Delacroix-Chevalier</td><td>DC12000-21&amp;nbsp;</td><td></td></tr><tr><td>Lung retractor</td><td>Delacroix-Chevalier</td><td>B803990</td><td></td></tr><tr><td>Allis clamp</td><td>Delacroix-Chevalier</td><td>DC45907-25&amp;nbsp;</td><td></td></tr><tr><td>O&amp;rsquo;Shaugnessy Dissector</td><td>Delacroix-Chevalier</td><td>B60650</td><td></td></tr><tr><td>18 blade knife</td><td>Delacroix-Chevalier</td><td>B130180</td><td></td></tr><tr><td>11 blade knife</td><td>Premiere</td><td>9311-2PK</td><td></td></tr><tr><td>Leriche haemostatic clamp</td><td>Delacroix-Chevalier</td><td>B86555</td><td></td></tr><tr><td>&lt;strong&gt;Data analysis&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Mann-Whitney and Chi-square tests</td><td>GraphPad</td><td>Prism 7</td><td></td></tr></tbody></table>

technique and patient selection criteria of right anterior mini-thoracotomy for minimal access aortic valve replacement

主动脉瓣狭窄已成为发达国家最普遍的心脏瓣膜病, 是由于这些人群的衰老引起的。病理发生率随着年龄的增长而增加65年。常规手术主动脉瓣置换通过中位胸骨已成为患者护理的黄金标准症状性主动脉瓣狭窄。然而, 随着患者风险状况的恶化, 采取了其他的治疗策略, 试图维持已建立的外科治疗取得的优良效果。其中一种方法是由经导管主动脉瓣植入术表示。尽管经导管主动脉瓣置换术治疗症状性主动脉瓣狭窄的高危患者的预后有所改善, 但许多患者仍保留手术主动脉瓣置换术的候选条件。为减少外科手术后主动脉瓣瓣膜置换患者的手术创伤, 在过去的十年中, 微创治疗方法引起了人们的兴趣。自1993年引入右前方开胸术进行主动脉瓣置换手术以来, 右前小切口和上半胸骨已成为心脏外科医生执行最小进入主动脉的主要切口方法。阀门更换。在切口位置旁边, 动脉插管部位代表主动脉瓣膜置换术中的第二个主要标志。两个最常用的动脉插管部位包括中央主动脉和股骨周围的方法。为了减少这些病人的手术创伤, 我们选择了一个右前方小切口的中心主动脉插管的方法。本协议详细描述了一种微创主动脉瓣置换技术, 并为患者选择标准提供建议, 包括心脏计算机层析成像测量。讨论了这种技术的适应症和局限性, 以及它的替代方案。

在表 2、表3、和表 4中使用非参数的曼恩惠特尼测试, 对连续变量 (显示为方法) 进行统计分析。分类变量以百分比形式显示在表 2、表3、和表 4中, 并通过卡方测试进行比较。统计分析是使用商用软件进行的, 其统计意义阈值设置在p< 0.05 中。
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Watch this Scientific Journal Video about Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement at JoVE.com

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

右前小切口主动脉瓣置换术的技术及患者选择标准

本协议的目的是详细描述的技术, 微创主动脉瓣置换通过右前小切口和中央主动脉插管。这种技术有可能提高患者的舒适度, 通过减少手术后的发病率, 促进降低住院时间和全球成本。

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The ...

technique-patient-selection-criteria-right-anterior-mini-thoracotomy

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

11.6K 次观看.  Institut de Cardiologie. 本协议的目的是详细描述的技术, 微创主动脉瓣置换通过右前小切口和中央主动脉插管。这种技术有可能提高患者的舒适度, 通过减少手术后的发病率, 促进降低住院时间和全球成本。

视频: Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Minimally Invasive Transverse Aortic Constriction in Mice

Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard open-chest transverse aortic constriction (TAC). Although transverse aortic constriction is a highly functional method for the induction of high pressure in the left ventricle, it is a more difficult and lengthy procedure due to its use of artificial ventilation with tracheal intubation. TAC is oftentimes also less survivable, as the newer method, MTAC, neither requires the cutting of the ribs and intercostal muscles nor tracheal intubation with a ventilation setup. In MTAC, as opposed to a thoracotomy to access to the chest cavity, the aortic arch is reached through a midline incision in the anterior neck. The thyroid is pulled back to reveal the sternal notch. The sternum is subsequently cut down to the second rib level, and the aortic arch is reached simply by separating the connective tissues and thymus. From there, a suture can be wrapped around the arch and tied with a spacer, and then the sternal cut and skin can be closed. MTAC is a much faster and less invasive way to induce left ventricular hypertension and enables the possibility for high-throughput studies. The success of the constriction can be verified using high-frequency trans-thoracic echocardiography, particularly color Doppler and pulsed-wave Doppler, to determine the flow velocities of the aortic arch and left and right carotid arteries, the dimension of the blood vessels, and the left ventricular function and morphology. A successful constriction will also trigger significant histopathological changes, such as cardiac muscle cell hypertrophy with interstitial and perivascular fibrosis. Here, the procedure of MTAC is described, demonstrating how the resulting flow changes in the carotid arteries can be examined with echocardiography, gross morphology, and histopathological changes in the heart.

Minimally invasive transverse aortic constriction (MTAC) conserves the essentials of regular transverse aortic constriction (TAC) while eliminating the use of a ventilator with tracheal intubation. It proves to be a highly desirable method for high-throughput studies on left ventricular overload, particularly in translational studies.

微创横向主动脉缩窄小鼠

Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard ...

科研

医学

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial valve might not meet the functional needs. The implantation of a too-small stented pericardial valve, leading to an effective orifice area indexed to a body surface area less than 0.85 cm2/m2, is regarded as prosthesis-patient mismatch (PPM). A PPM negatively affects the regression of left ventricular hypertrophy and thus the normalization of left ventricular function and the alleviation of symptoms. Persistent left ventricular hypertrophy is associated with an increased risk of arrhythmias and sudden cardiac death. In the case of predictable PPM, there are three options: 1) accept the PPM resulting from the implantation of a stented pericardial valve when comorbidities of the patient forbid the more technically demanding operative technique of implanting a larger prosthesis, 2) enlarge the aortic root to accommodate a larger stented valve substitute, or 3) implant a stentless biological valve or a homograft. Compared to classical aortic valve replacement with stented pericardial valves, the full-root implantation of stentless aortic xenografts offers the possibility of implanting a 3-4 mm larger valve in a given patient, thus allowing significant reduction in transvalvular gradients. However, a number of cardiac surgeons are reluctant to transform a classical aortic valve replacement with stented pericardial valves into the more technically challenging full-root implantation of stentless aortic xenografts. Given the potential hemodynamic advantages of stentless aortic xenografts, we have adopted full-root implantation to avoid PPM in patients with small aortic roots necessitating an aortic valve replacement. Here, we describe in detail a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses. Limitations of this technique and alternative options are discussed.

Full-root aortic valve replacement by stentless aortic xenograft is a viable option in patients with small aortic roots. We describe, a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses, and discuss its limitations and alternative options.

全根主动脉瓣置换主动脉瓣狭窄主动脉异种移植患者小主动脉根

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial ...

Technique of Minimally Invasive Transverse Aortic Constriction in Mice for Induction of Left Ventricular Hypertrophy

Transverse aortic constriction (TAC) in mice is one of the most commonly used surgical techniques for experimental investigation of pressure overload-induced left ventricular hypertrophy (LVH) and its progression to heart failure. In the majority of the reported investigations, this procedure is performed with intubation and ventilation of the animal which renders it demanding and time-consuming and adds to the surgical burden to the animal. The aim of this protocol is to describe a simplified technique of minimally invasive TAC without intubation and ventilation of mice. Critical steps of the technique are emphasized in order to achieve low mortality and high efficiency in inducing LVH.
Male C57BL/6 mice (10-week-old, 25-30 g, n=60) were anesthetized with a single intraperitoneal injection of a mixture of ketamine and xylazine. In a spontaneously breathing animal following a 3-4 mm upper partial sternotomy, a segment of 6/0 silk suture threaded through the eye of a ligation aid was passed under the aortic arch and tied over a blunted 27-gauge needle. Sham-operated animals underwent the same surgical preparation but without aortic constriction. The efficacy of the procedure in inducing LVH is attested by a significant increase in the heart/body weight ratio. This ratio is obtained at days 3, 7, 14 and 28 after surgery (n = 6 - 10 in each group and each time point). Using our technique, LVH is observed in TAC compared to sham animals from day 7 through day 28. Operative and late (over 28 days) mortalities are both very low at 1.7%.
In conclusion, our cost-effective technique of minimally invasive TAC in mice carries very low operative and post-operative mortalities and is highly efficient in inducing LVH. It simplifies the operative procedure and reduces the strain put on the animal. It can be easily performed by following the critical steps described in this protocol.

The aim of this protocol is to describe step-by-step the technique of minimally invasive transverse aortic constriction (TAC) in mice. By elimination of intubation and ventilation which are mandatory for the commonly used standard procedure, minimally invasive TAC simplifies the operative procedure and reduces the strain put on the animal.

小鼠横主动脉狭窄诱导左心室肥厚的技术研究

Transverse aortic constriction (TAC) in mice is one of the most commonly used surgical techniques for experimental investigation of pressure ...

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures prevents a number of cardiac surgeons from incorporating them into their practice. The aim of this protocol is to describe a simplified and user-friendly technique of an aortic valve-sparing root replacement (VSRR) procedure by re-implantation of the aortic valve. Proper selection of patients and limitations of the technique are discussed.
In 54 consecutive patients, normal appearing aortic valves were re-implanted in a commercially available polyester prosthesis with pre-shaped sinuses by a simplified and standardized technique. Placement of the first row of the proximal suture line, choice of the prosthesis size, and adjustment of the height of the commissures of the patient to the fixed height of the sinus portion of the prosthesis were slightly modified from the reference techniques with the aim of increasing its feasibility for use by other cardiac surgeons. Early mortality and morbidity as well as 5-year survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were collected in all patients.
Thirty-day mortality, re-sternotomy for bleeding, re-sternotomy for mediastinitis, and the incidence of stroke were very low, 1.8% for each (1 of 54). No patient required permanent pace-maker implantation. At 5 years, survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were 97.5%, 95.2%, and 91.6%, respectively.
Mid-term results of our standardized technique of re-implantation of the aortic valve for valve-sparing aortic root replacement are very good and compare with more complex techniques reported by experienced surgeons. By following the present protocol of the standardized re-implantation technique, a greater number of cardiac surgeons can perform this procedure with comparable good results.

Valve-sparing aortic root replacement has the advantage of preserving the patient&#39;s own aortic valve. The complexity of the reported techniques to date restricts their use to a limited number of cardiac surgeons. This protocol describes step-by-step a standardized technique reproducible by a greater number of cardiac surgeons.

主动脉瓣重置术治疗瓣膜备用主动脉根置换的规范化技术

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures ...

Semi-Minimal Invasive Method to Induce Myocardial Infarction in Rats and the Assessment of Cardiac Function by an Isolated Working Heart System

Myocardial infarction (MI) remains the main contributor to morbidity and mortality worldwide. Therefore, research on this topic is mandatory. An easily and highly reproducible MI induction procedure is required to obtain further insight and better understanding of the underlying pathological changes. This procedure can also be used to evaluate the effects or potency of new and promising treatments (as drugs or interventions) in acute MI, subsequent remodeling and heart failure (HF). After intubation and pre-operative preparation of the animal, an anesthetic protocol with isoflurane was performed, and the surgical procedure was conducted&#160;quickly. Using a minimally invasive approach, the left anterior descending artery (LAD) was located and occluded by a ligature. The occlusion can be performed acutely for subsequent reperfusion (ischemia/reperfusion injury). Alternatively, the vessel can be ligated permanently to investigate the development of chronic MI, remodeling or HF. Despite common pitfalls, the drop-out rates are minimal. Various treatments such as remote ischemic conditioning can be examined for their cardioprotective potential pre-, peri- and post-operatively. The post-operative recovery was quick as the anesthesia was precisely controlled and the duration of the operation was short. Post-operative analgesia was administered for three days. The minimally invasive procedure reduces the risk of infection and inflammation. Furthermore, it facilitates rapid recovery. The &#8220;working heart&#8221; measurements were performed ex vivo and enabled precise control of preload, afterload and flow. This procedure requires specific equipment and training for adequate performance. This manuscript provides a detailed step-by-step introduction for conducting these measurements.

This article presents an efficient method to perform myocardial ischemia and subsequent chronic reperfusion in rats using a minimally invasive approach. In addition, left ventricular hemodynamic function of rats is assessed by echocardiography and isolated working heart methods.&#160;

诱导大鼠心肌梗死的半微创方法及独立工作心脏系统对心脏功能的评估

Myocardial infarction (MI) remains the main contributor to morbidity and mortality worldwide. Therefore, research on this topic is mandatory. An easily ...

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation

During the last decade, transcatheter aortic valve implantation (TAVI) has evolved as a well-established therapy for aging patients suffering from symptomatic severe aortic valve stenosis. This is also reflected in the recently updated international guidelines on managing patients with valvular heart disease. A transfemoral&#160;(TF) TAVI&#160;approach has proven superior to alternative access strategies. With the introduction of intravascular lithotripsy (IVL), patients with calcified iliofemoral vascular disease and borderline intraluminal diameters have also become candidates for percutaneous TF-TAVI. Moreover, IVL reduces the risk of major vascular complications by modifying the superficial and deep vascular calcium, thereby changing the vessel compliance and controlling luminal expansion. In this way, IVL has shown to safely facilitate TF delivery of TAVI devices in patients with calcified peripheral artery disease. The present article aims to provide a detailed step-by-step description on how to perform IVL-assisted TF-TAVI safely and efficiently. Furthermore, a literature review on the outcomes obtained with this technology is included, along with a concise discussion on this unique TAVI approach.

Transcatheter aortic valve implantation (TAVI) has been shown to generate the best clinical outcomes when performed by the percutaneous transfemoral approach. Intravascular lithotripsy (IVL) can facilitate a transfemoral process in patients with calcified iliofemoral vascular disease and borderline intraluminal diameters. The present protocol describes IVL-assisted transfemoral TAVI.

During the last decade, transcatheter aortic valve implantation (TAVI) has evolved as a well-established therapy for aging patients suffering from ...

Chronic Ovine Model of Right Ventricular Failure and Functional Tricuspid Regurgitation

The pathophysiology of severe functional tricuspid regurgitation (FTR) associated with right ventricular dysfunction is poorly understood, leading to suboptimal clinical results. We set out to establish a chronic ovine model of FTR and right heart failure to investigate the mechanisms of FTR. Twenty adult male sheep (6-12 months old, 62 &#177; 7 kg) underwent a left thoracotomy and baseline echocardiography. A pulmonary artery band (PAB) was placed and cinched around the main pulmonary artery (PA) to at least double the systolic pulmonary artery pressure (SPAP), inducing right ventricular (RV) pressure overload and signs of RV dilatation. PAB acutely increased the SPAP from 21 &#177; 2 mmHg to 62 &#177; 2 mmHg. The animals were followed for 8 weeks, symptoms of heart failure were treated with diuretics, and surveillance echocardiography was used to assess for pleural and abdominal fluid collection. Three animals died during the follow-up period due to stroke, hemorrhage, and acute heart failure. After 2 months, a median sternotomy and epicardial echocardiography were performed. Of the surviving 17 animals, 3 developed mild tricuspid regurgitation, 3 developed moderate tricuspid regurgitation, and 11 developed severe tricuspid regurgitation. Eight weeks of pulmonary artery banding resulted in a stable chronic ovine model of right ventricular dysfunction and significant FTR. This large animal platform can be used to further investigate the structural and molecular basis of RV failure and functional tricuspid regurgitation.

Right ventricular failure and functional tricuspid regurgitation are associated with left-sided heart disease and pulmonary hypertension, which contribute significantly to morbidity and mortality in patients. Establishing a chronic ovine model to study right ventricular failure and functional tricuspid regurgitation will help in understanding their mechanisms, progression, and possible treatments.

右心室衰竭和功能性三尖瓣反流的慢性绵羊模型

The pathophysiology of severe functional tricuspid regurgitation (FTR) associated with right ventricular dysfunction is poorly understood, leading to ...

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

Endoscopic mitral valve surgery (EMS) has become a standard of care at specialized heart centers, further reducing surgical trauma compared to a traditional minimally invasive, thoracotomy-based approach. Exposure of the groin vessels for the establishment of cardiopulmonary bypass (CPB) via surgical cutdown in minimally invasive surgery (MIS) may result in wound healing disorders or seroma formation. The avoidance of surgical exposure of the groin vessels by using fully percutaneous techniques for the insertion of a CPB cannula with the implementation of vascular pre-closure devices has the potential to reduce these complications and improve clinical results. Herein, we present the utilization of a novel plug based vacsular closure device with a resobable collagen plug and the absence of suture material for closure of the arterial access for CPB in MIS. While this device was initially predominantly used in transcatheter aortic valve implantation (TAVI) procedures, with its safety and feasibility shown, we herein show that it can be used in CPB cannulation, since it is capable of closing arterial access sites up to 25 French (Fr.) in size. This device may be suitable to significantly reduce groin complications in MIS and simplify the establishment of CPB. Here, we describe the fundamental steps of EMS, including percutaneous groin cannulation and decannulation using a vascular closure device.

This protocol demonstrates in detail how to perform fully endoscopic mitral valve surgery (EMS) with percutaneous cannulation of the groin vessels, using a percutaneous plug-based vascular closure device. Fundamental steps and useful instructions are described in detail for each step.

经皮插管腹股沟血管全内镜二尖瓣修复术

Endoscopic mitral valve surgery (EMS) has become a standard of care at specialized heart centers, further reducing surgical trauma compared to a ...

用于研究压力超负荷诱发的心力衰竭的升主动脉束带

A Minimally Invasive Model of Aortic Stenosis in Swine

Large animal models of heart failure play an essential role in the development of new therapeutic interventions due to their size and physiological similarities to humans. Efforts have been dedicated to creating a model of pressure-overload induced heart failure, and ascending aortic banding while still supra-coronary and not a perfect mimic of aortic stenosis in humans, closely resembling the human condition.
The purpose of this study is to demonstrate a minimally invasive approach to induce left ventricular pressure overload by placing an aortic band, precisely calibrated with percutaneously introduced high-fidelity pressure sensors. This method represents a refinement of the surgical procedure (3Rs), resulting in homogenous trans-stenotic gradients and reduced intragroup variability. Additionally, it enables swift and uneventful animal recovery, leading to minimal mortality rates. Throughout the study, animals were followed for up to 2 months after surgery, employing transthoracic echocardiography and pressure-volume loop analysis. However, longer follow-up periods can be achieved if desired. This large animal model proves valuable for testing new drugs, particularly those targeting hypertrophy and the structural and functional alterations associated with left ventricular pressure overload.

作者聚焦:开发用于可靠且可重复的心血管研究的微创大型动物模型 

This protocol describes a minimally invasive surgical procedure for ascending aortic banding in swine.

猪主动脉瓣狭窄的微创模型

Large animal models of heart failure play an essential role in the development of new therapeutic interventions due to their size and physiological ...

右前小切口主动脉瓣置换术的技术及患者选择标准

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Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation

右心室衰竭和功能性三尖瓣反流的慢性绵羊模型

经皮插管腹股沟血管全内镜二尖瓣修复术

猪主动脉瓣狭窄的微创模型

猪主动脉瓣狭窄的微创模型