Bu eser RT. için İsviçre kardiyovasküler Vakfı'nın hibe (N ° 32117) tarafından desteklenmiştir

Protokol insan araştırma Etik Kurulu kurumsal kuralları izler.
1. ön seçim hastanın
<ol><li>60 mm pre-operative bilgisayar tomografi (CT) tarama kullanarak geçmeyen Valsalva sinüsleri genişleme ile hasta belirleyin.</li>
	<li>Sonra bu hastalar arasında normal veya normal yakın görünen aort kapak cusps üzerinde onların pre-operative Ekokardiyografi ile bir alt grubu seçin.</li>
	<li>Aortik kök değiştirme yordamı tutumlu bir vana olasılığı personeli bilgilendirmek.</li>
	<li>Aort kapak incelenmesi sonra çimentosu son karar. Kireçlenmeler, cusps ve/veya kalınlaşma ve onların serbest marjin retraksiyon yokluğunda doğrulayın.</li>
</ol>2. ameliyat hazırlığı
Not: Kurumsal yönergeleri ve önerileri yetişkin kalp cerrahisi hastalar için cerrahi için hazırlık izler.
<ol><li>Cerrahi suite hazırlamak ve hasta ameliyat için daha önce13açıklandığı gibi.</li>
</ol>3. cerrahi
<ol><li>Yukarıda açıklanan13 (şekil 1A) olarak ortalama bir yöntemdir kalbine erişimi.</li>
	<li>Aortik kök yenisiyle değiştirme için hazırlayın.
	<ol>
<li>Çin-borulu kavşağında artan aort Carpentier diseksiyon Forseps ile kapmak. #11-bıçak bıçak ile yatay bir açılış yapmak.</li>
		<li>Aortotomy yatay ve çepeçevre Metzenbaum makas ile tamamlayın.</li>
		<li>Sonra aort damarı kesmiş, kireçlenmeler, cusps ve/veya kalınlaşma ve onların serbest marjin retraksiyon yokluğunda doğrulayın. Koroner ostia denetleyin.</li>
		<li>Ücretsiz çevreleyen dokudan dış görünüş, Sigara-koroner sinüs aşağı sol atrium çatısı incelemek.</li>
		<li>5 mm cusp (şekil 1B) ekleme için bağlı aort duvar kalıntısı bırakarak cömert bir dairesel yama ile aort duvarından sağ koroner ostium bağlantısını kesin.</li>
		<li>Komissür arasında sigara koroner ve sağ koroner sinüs çevreleyen doku üzerinden ücretsiz.</li>
		<li>Ücretsiz sağ ventrikül çıkım yolu sağ koroner sinüs aort duvar kalıntısı dış yönünü incelemek.</li>
		<li>Sol atriyum çatı aşağı sigara koroner ve sol koroner sinüs arasında komissür dış yönünü ücretsiz.</li>
		<li>Koroner sinüs bırakarak 5 mm Cusp'ın ekleme için bağlı aort duvar kalıntısı, aort duvarına tüketim.</li>
		<li>Sağ ve sol koroner sinüs çevreleyen doku üzerinden arasında komissür dış yönünü ayırın. Pulmoner arter zarar değil için dikkat ediniz.</li>
		<li>Sol koroner ostium 5 mm cusp (şekil 1B) ekleme için bağlı aort duvar kalıntısı bırakarak cömert bir dairesel yama ile aort duvarından bağlantısını kesin. Sol ana koroner arter onun ilk 10 mm üzerinde seferber.</li>
		<li>Ücretsiz sol koroner sinüs Sol atriyum çatıdan aort duvar kalıntısı dış yönünü incelemek.</li>
		<li>Yatak 4/0 polipropilen kalış dikiş her komissür üstüne koy.</li>
	</ol></li>
	<li>Proksimal protez implantasyonu başlatın.
	<ol>
<li>Proksimal Anastomoz ilk satır 12 yatak pledgeted 2/0 örgülü polyester dikiş tarafından gerçekleştirin. Bu dikişler çepeçevre yatay düzlemde 1-2 mm cusps ve koroner sigara ve sağ koroner sinüs (şekil 2A) arasında komissür dışında commissural üçgen temelini ekleme aşağıda koymak.</li>
		<li>Commissural üçgeni arasında sigara koroner ve sol koroner sinüs temelini ilk yatak dikiş koymak. İkinci ve üçüncü dikiş sigara koroner cusp ekleme altında 1-2 mm arasında sigara koroner ve sağ koroner sinüs komissür yönünü koymak.</li>
		<li>Yer yanında üçüncü bir commissural üçgeni arasında sigara koroner ve sağ koroner sinüs tabanı kaçınarak ve böylece değil ödün tarafından sigara koroner ve sağ koroner sinüs arasında komissür yönünde ileri dikiş Membranöz septum.</li>
		<li>Sağ koroner sinüs komissür arasında sigara koroner ve sağ koroner böylece membranöz septum (şekil 2B) atlama sinüs, commissural üçgen Bankası uzak 2 mm ilk dikiş başlatın.</li>
		<li>Sol ve sağ koroner sinüs arasında komissür yönünde sağ koroner sinüs aşağıdaki dikiş koymak.</li>
		<li>Yer ileri doğru koroner sinüs komissür sol ve sağ koroner sinüs arasında commissural üçgen temelini dikiş.</li>
		<li>Ardından, 4 eşit uzaklıkta yatak dikiş sol koroner Cusp'ın sol koroner sinüs fiksasyonu için ekleme altında 1-2 mm geçmektedir.</li>
		<li>Protezin boyutunu seçmek için 4-6 mm konforlu sol ventrikül aort kapak kavşaktan geçen bir piyasada bulunan biyolojik Vana sizer boyutunu ekleyin.</li>
		<li>Commissural konaklama dikiş ve commissural üçgeni temeli, yatak dikiş arasında commissural yüksekliği belirlemek. Önceden ayarlanmış sinüsler protezin hastaya commissural yükseklikleri ayarlamak için iç-dış onun Çin borulu Kavşağı civarında protezin 4/0 polipropilen commissural kal pass tasarlamak.</li>
		<li>Sol ve sağ koroner sinüs arasında komissür yüksekliğini kez biraz daha az bu diğer iki daha olduğunu unutmayın. Çepeçevre 2 mm ölçülen commissural yükseklik commissures olan için protezin sinüsler yüksekliğini adapte ve yatak dikiş protez ile ilk satırı iletebilmesi için aşağıda protezin alt boyun kırpın.</li>
		<li>Şimdi yatak dikiş Inside-out protez geçmektedir. Böylece Vana (şekil 3A) içine yerleştirerek protez aşağı kaydırın. Yatak dikiş yavaşça kravat ve kesin.</li>
		<li>Üç 5/0 polipropilen sütür, her sinüs için bir çalışan tarafından Proksimal Anastomoz ikinci satır başlatın.</li>
		<li>İlk 5/0 polipropilen çalışan dikiş içinde protez aort duvar kalıntısı yanında tabi paralel cusp komissür sol ve sağ koroner arasında kadar ve daha sonra th kadar ekleme düzeltmek için sol koroner sinüs nadir, başlar e komissür koroner sinüs ve sol arasında. 2 uçları hafif gerilim altında koymak.</li>
		<li>İkinci 5/0 polipropilen çalışan dikiş içinde protez aort duvar kalıntısı yanında tabi paralel Cusp'ın sağ ve sol koroner arasında komissür kadar ekleme düzeltmek için sağ koroner sinüs nadir, devam edin ve o zaman doğru ve koroner sinüs komissür kadar. 2 uçları hafif gerilim altında koymak.</li>
		<li>Üçüncü 5/0 polipropilen çalışan dikiş nadir, Sigara-koroner yanında tabi paralel cusp komissür sigara koroner ve sol koroner sinüs arasında kadar ekleme içinde protez aort duvar kalıntısı düzeltmeye sinüs yerleştirin.</li>
		<li>Proksimal Anastomoz ikinci satırındaki paralel cusp komissür sigara koroner ve sağ koroner sinüs arasında kadar ekleme olarak aort duvar kalıntısı sabitleme ile bitirmek. Her komissür iki dikiş-ucu birlikte (3B rakam) bağla.</li>
		<li>Aortik Regürjitasyon yokluğunda protez serum doldurma ve sağ pulmoner ven ve mitral kapak ile sol ventrikül yerleştirilmiş havalandırma emici uygulamak ile kontrol edin.</li>
	</ol></li>
	<li>Koroner ostia için protez (şekil 4) yeniden bağlayın.
	<ol>
<li>Bir düğme delik sol koroner ostium düzeltme eki boyutunu için protezin sol sinüs oluşturun.</li>
		<li>Anastomoz protez içten dışa ve sol koroner ostium dışında içinde için düğme delik nadir, 6/0 polipropilen çalışan dikiş tarafından başlar.</li>
		<li>İkinci dikiş 2 mm içten dışa ilki protezin sağına yerleştirin ve sol koroner ostium anastomoz doğru ridge orta yüksekliği kadar dışarıda. Işık gerilim altında dikiş son ver.</li>
		<li>Anastomoz dışında protez ve diğer ucunu karşılamak için sol koroner ostium içten dışa sol sırt üzerinde çalışan dikiş devam. İki ucu birbirine bağlayan.</li>
		<li>Bir düğme delik sağ koroner ostium düzeltme eki boyutunu için Protezin doğru sinüs oluşturun.</li>
		<li>Sağ koroner ostium protez için içten dışa ve içinde dışında protez içine sağ koroner ostium nadir başlayan bir 6/0 polipropilen çalışan dikiş tarafından bağlayın.</li>
		<li>Anastomoz doğru ridge orta yüksekliğine dikiş devam etmek ve sonuna hafif gerilim altında koymak.</li>
		<li>Anastomoz diğer ucunu tanışmak anastomoz sol ridge çalıştırarak tamamlayın. İki ucu birbirine bağlayan.</li>
	</ol></li>
	<li>Distal anastomoz (şekil 4) gerçekleştirin.
	<ol>
<li>Distal ucunun protezin nadir, anastomoz içini dışını ve içine distal aort üzerinden dışında 5/0 polipropilen çalışan dikiş tarafından artan başlatın. Dikiş kadar anastomoz doğru ridge orta yüksekliğini çalıştırın.</li>
		<li>Distal anastomoz yapmama diğer ucunu karşılamak için sol sırtta dikişi çalıştırarak tamamlayın. Uçları birbirine bağlayan.</li>
		<li>Trendelenburg pozisyonunda ameliyat masasına yatırmak. Tam akış % 50 azaltmak ve yavaş yavaş aortik çapraz kelepçe sol ventrikül havalandırma nazik aspirasyon altında kaldırmak pompa akışı sağlar.</li>
		<li>Özgeçmiş kardiyo-pulmoner tam akışını atlamak. Aşırı kanama cerrahi ameliyat alanı denetleyin.</li>
		<li>37 ° C hastaya ısıt ve kardiyo-pulmoner bypass hastadan ayrı. Kan basıncı dengelemek, heparin (3 mg/kg 300 U/kg ila heparin karşılık gelen) 1:1 oranında IV infüzyon protamine tarafından nötralize etmek.</li>
		<li>Hemostazın için kontrol edip gerektiği gibi göğüs drenaj sokun. Standart moda göğsünden sternal telleri ile göğüs kemiği ve iki kat13' te absorbe dikiş ile yumuşak doku reapproximating kapatın.</li>
	</ol></li>
</ol>4. ameliyat sonrası hasta bakımı
<ol><li>Yoğun bakım ünitesi transferi, hasta kardiyak Cerrahi operasyon aortik kök13için standart ameliyat sonrası Bakımı sunabilmemiz.</li>
</ol>

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Yazarlar ifşa gerek yok.

Vana tutumlu aort cusps, normal ya da normal yakınındaki anevrizması aortik kökü ile sunmak hastalarda aortik kök yerini kompozit greft aorta ve aort kapak ile değiştirilmesi için daha fizyolojik ve dolayısıyla çekici bir alternatif mekanik veya doku Vana. Bu protokol için biz basitleştirilmiş bir vana-tutumlu aort tekniği tarif kök yerine yeniden aort kapak implantasyonu tarafından. Daha önce raporlanmış teknikleri3,8çoğunluğu aksine, bu ...

Son yirmi yıl içinde normal veya normal yakınındaki aort cusps aortik kök anevrizması cerrahi tedavisinde cerrahi işlemler yerel aort kapak1,2koruma hedefleyen bir dizi sayesinde gelişmiştir, 3,4,5. Vana tutumlu aortik kök yerine yeniden bir sentetik greft1,3,4,' daki6 aort kapak implantasyonu veya remodeling bir teknik temelde başarılı hangi aortik kökü2fizyolojik anatomisi geri yükler. Normal bir aort kapak korunması aortik kök değiştirme sırasında belirgin avantajları rağmen birçok kalp cerrahları aort kapak ya da mekanik veya biyolojik Vana yedekler ile değiştirin. Göğüs cerrahları Derneği veri tabanına göre aortik kök yerine 2004-2010 arasında Amerika Birleşik Devletleri'nde yapılan hastaların sadece % 14 Vana tutumlu bir yordam7aldı.
Orijinal yeniden implantasyon tekniği, aort kapak içinde borulu yatay bükük sentetik greft8dikmiş. Her ne kadar bu teknik aort halka stabilize, Valsalva sinüsleri ortadan kaldırır. Valsalva sinüsleri yeniden oluşturmak için bu teknik yanı sıra diğer yazarlar9mucit tarafından birçok değişikliği uğramıştır. Bu teknik bir varyasyonu içinde commissures destekleyen aort duvar kalıntıları boyuna açıklıklar içinde borulu polietilen tereftalat greft4yapılmış içine dikmiş Rama vd.tarafından teklif edildi.
Remodeling tekniği aortik kökü daha anatomik yeniden elde ancak aort halka desteklenmeyen ve gelecekteki dilatasyon maruz bırakır. Çeşitli cerrahi teknikleri aort Annulus Bankası aortik kök remodeling,'terzi alt commissural aort annuloplasty10, sirkumferansiyel dikiş annuloplasty11ve iç veya dış annuloplasty de dahil olmak üzere dizayn edilmiştir kısmi veya tam sentetik tarafından12ara.
Deneyimli yazarlar tarafından bildirilen mükemmel sonuçlar rağmen bu yordamlardan karmaşıklığı ve periyodik değişiklikler onların tekrarlanabilirlik diğer kardiyak cerrahlar tarafından engel ve böylece korumasını yararına uygun hasta sayısı önlemek onların kendi aort kapak. Yeniden implantasyon tekniği tekrarlanabilirlik geliştirmek için biz piyasada bir sentetik greft ile bir uncrimped, önceden ayarlanmış sinüs kısmında kullanılan ve implantasyon tekniği Basitleştirilmiş. Bu iletişim kuralının amacı ayrıntılı olarak bu standart ve tekrarlanabilir teknik özel yönetimi proksimal dikiş hattı ve commissures greft içindeki yerleşimini ve greft seçiminde ilk satırının vurgu ile tarif etmektir boyutu. Erken sonuçları ve orta dönem sonuçları sunulmuştur. Hastalar için uygun seçim ve bu yordamı sınırlamaları ele alınmıştır.

<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>Atrial caval venous cannula 34/48Fr.</td><td>Medtronic</td><td>93448</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>Retrograde 14Fr. cardioplegia cannula&amp;nbsp;</td><td>Edwards</td><td>NPC014&amp;nbsp;</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;Name&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Catalog Number&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>Pre-shaped sinus graft</td><td></td><td></td><td></td></tr><tr><td>Cardioroot 28 mm</td><td>Maquet</td><td>HEWROOT0028</td><td></td></tr><tr><td>Cardioroot 30 mm</td><td>Maquet</td><td>HEWROOT0030</td><td></td></tr><tr><td>Cardioroot 32 mm</td><td>Maquet</td><td>HEWROOT0032</td><td></td></tr><tr><td>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Catalog Number&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>Electrocautery</td><td>Covidien</td><td>Force FX</td><td></td></tr><tr><td>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Catalog Number&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</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>Polypropylene 6/0</td><td>Ethicon</td><td>EH7400H</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>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Catalog Number&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>Micro knife Sharpoint&amp;nbsp;</td><td>TYCO Healthcare PTY&amp;nbsp;</td><td>78-6900</td><td></td></tr><tr><td>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Catalog Number&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</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>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Catalog Number&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>&lt;strong&gt;Instruments:&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Cooley vascular aortic clamp</td><td>Delacroix-Chevalier</td><td>DC40810-16</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>Micro needle holder Jacobson</td><td>Delacroix-Chevalier</td><td>DC50002-21&amp;nbsp;</td><td></td></tr><tr><td>Micro scisors Jacobson</td><td>Delacroix-Chevalier</td><td>DC20057-21&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>Leriche haemostatic clamp</td><td>Delacroix-Chevalier</td><td>B86555</td><td></td></tr><tr><td>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Catalog Number&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>&lt;strong&gt;Data analysis&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Kaplan Meier curves</td><td>GraphPad</td><td>Prism 7</td><td></td></tr></tbody></table>

standardized technique of aortic valve re-implantation for valve-sparing aortic root replacement

Normal bir aort kapak korunması aortik kök değiştirme sırasında belirgin avantajları rağmen yordamları tutumlu Vana karmaşıklığı kalp cerrahları çok sayıda antrenmanlarını birleşmeyle gelen engeller. Bu iletişim kuralının amacı bir basitleştirilmiş ve kullanıcı dostu teknik bir aort kapak tutumlu kök değiştirme (VSRR) yordam yeniden aort kapak implantasyonu tarafından tarif etmektir. Hastaların uygun seçimi ve teknik sınırlamaları ele alınmıştır.
54 ardışık hastalarda, normal görünen aortik valf içinde önceden ayarlanmış sinüsler ile piyasada bulunan polyester protezi Basitleştirilmiş ve standart tekniği ile yeniden implante edildi. Proksimal dikiş hattı ilk satırı, protez boyutu seçimi ve commissures hastanın protezin sinüs bölümü sabit yüksekliği yükseklik ayarını yerleşimini biraz üzerinden başvuru teknikleri ile değiştirilmiş onun fizibilite diğer kardiyak cerrahlar tarafından kullanılacak artırılması amacıyla. Tüm hastalarda erken mortalite ve morbidite yanı sıra 5 yıllık sağkalım, aort kapak reoperation gelen özgürlük ve özgürlük tekrarlayan orta Regürjitasyon toplanmıştır.
30 günlük mortalite, re-yöntemdir kanama, re-Sternotomiden için mediastinitis ve inme insidansı çok vardı için düşük, %1,8 54 her (1) için. Hiçbir hasta kalıcı pace-maker implantasyon gerekli. 5 yıl, hayatta kalma, aort kapak reoperation gelen özgürlük ve özgürlük tekrarlayan orta Regürjitasyon % 97.5 ve %95.2 %91,6, sırasıyla idi.
Orta dönem sonuçları yeniden Vana-tutumlu aort için aort kapak implantasyonu standart bizim teknik kök yerine çok iyi ve tecrübeli cerrahlar tarafından bildirilen daha karmaşık teknikleri ile karşılaştırın. Standart yeniden implantasyon tekniğinin mevcut iletişim kuralı takip ederek, kalp cerrahları daha fazla sayıda karşılaştırılabilir iyi sonuçlar ile bu yordamı gerçekleştirebilirsiniz.

İstatistiksel analiz:
Sürekli değişkenler ortalama ± standart sapma ve yüzde olarak kategorik değişkenler olarak sunulur. Kaplan-Meier eğrileri hayatta kalma, aort kapak reoperation gelen özgürlük ve özgürlük bir ticari yazılım paketi ile tekrarlayan orta yetersizliği üzerinden hesaplanır.
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Watch this Scientific Journal Video about Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement at JoVE.com

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

Vana tutumlu aortik kök yerine hastanın kendi aort kapak koruyarak avantaja sahiptir. Tarihi için bildirilen teknikleri karmaşıklığı kalp cerrahları sınırlı sayıda için kullanımları kısıtlar. Bu iletişim kuralı adım adım açıklayan bir standart tekniği kalp cerrahları daha fazla sayıda tekrarlanabilir.

Aort kapak yeniden implantasyon Vana-tutumlu aort için standart tekniği kök değiştirme

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

standardized-technique-aortic-valve-re-implantation-for-valve-sparing

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

13.9K Görüntüleme.  Hopitaux de Paris (APHP), Institut de Cardiologie. Vana tutumlu aortik kök yerine hastanın kendi aort kapak koruyarak avantaja sahiptir. Tarihi için bildirilen teknikleri karmaşıklığı kalp cerrahları sınırlı sayıda için kullanımları kısıtlar. Bu iletişim kuralı adım adım açıklayan bir standart tekniği kalp cerrahları daha fazla sayıda tekrarlanabilir.

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

Orthotopic Aortic Transplantation in Mice for the Study of Vascular Disease

Vascular procedures involving anastomoses in the mouse are generally thought to be difficult and highly dependent on the skill of the individual surgeon. This is largely true, but there are a number of important principles that can reduce the difficulty of these procedures and enhance reproducibility. Orthotopic aortic transplantation is an excellent procedure in which to learn these principles because it involves only two end-to-end anastomoses, but requires good suturing technique and handling of the vessels for consistent success. This procedure begins with the procurement of a length of abdominal aorta from a donor animal, followed by division of the native aorta in the recipient. The procured aorta is then placed between the divided ends of the recipient aorta and sutured into place using end-to-end anastomoses. To accomplish this objective successfully requires a high degree of concentration, good tools, a steady hand, and an appreciation of how easily the vasculature of a mouse can be damaged, resulting in thrombosis. Learning these important principles is what occupies most of the beginner's time when learning microsurgery in small rodents. Throughout this protocol, we refer to these important points. This model can be used to study vascular disease in a variety of different experimental systems1-8. In the context shown here, it is most often used for the study of post-transplant vascular disease, a common long-term complication of solid organ transplantation in which intimal hyperplasia occurs within the allograft. The primary advantage of the model is that it facilitates quantitative morphometric analyses and the transplanted vessel lies contiguous to the endogenous vessel, which can serve as an additional control9. The technique shown here is most often used for mice weighing 18-25 grams. We have accumulated most of our experience using the C57BL/6J, BALB/cJ, and C3H/HeJ strains.

We describe a technique in which a section of the abdominal aorta from a mouse is transplanted orthotopically to just below the renal arteries in an allogeneic or syngeneic recipient. This technique can be useful in studies in which transplantation of large arteries of uniform size is deemed advantageous.

Damar Hastalığı Çalışmaları Farelerde Ortotopik Aort Nakli

Vascular procedures involving anastomoses in the mouse are generally thought to be difficult and highly dependent on the skill of the individual surgeon. ...

Tıp

A New Murine Model of Endovascular Aortic Aneurysm Repair

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 19901 in a rat, then described in mice2. Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.

Histological and biochemical modifications after aneurysm endograft exclusion are still unclear. We describe a new model of endograft implantation on a murine aneurysm. Through thrombus analysis with and without persistant circulating blood stream interface, and new endovascular biomaterials evaluation, this model will help to better understand endovascular aneurysm exclusion pathobiology.

Endovasküler Aort Anevrizma Onarımı Yeni Bir murin Modeli

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of ...

Using the Sleeve Technique in a Mouse Model of Aortic Transplantation - An Instructional Video

Orthotopic aortic transplantation using the sleeve technique reduces injury to the aorta with failure rate of only 10-20%. The time to anastomose the aorta in mice using the sleeve method was short and easy averaging 20 min, permitting studies of iso/allo grafts. The following article describes the aortic transplantation procedure used in our laboratory. The mice were anesthetized with a mixture of 1.5% volume isoflurane and 100% oxygen through a face mask. At this point, the segment of the aorta between the renal arteries and its bifurcation was separated from the vena cava, freely prepared and clampedat the proximal and distal segments with a single silk suture. Prior to the removal of the aorta, a saline solution containing heparin was injected into the inferior vena cava. Then the aorta was cut between the clamps and a saline heparin solution was used to flush the lumen. The sleeve technique with monofilament sutures was used in order to transplant the abdominal aorta in the orthotopic position.

We present an orthotopic aortic transplantation model using the sleeve technique in mice. It is a very rapid anastomosis method, which can be employed in studies of vascular disease.

Kol tekniği aort transplantasyonu - eğitici bir Video bir fare Model kullanma

Orthotopic aortic transplantation using the sleeve technique reduces injury to the aorta with failure rate of only 10-20%. The time to anastomose the ...

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.

Farelerde Minimal İnvaziv Enine Aort Konstrüksiyon

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

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.

Küçük Aort Köklü Hastalarda Stentless Aortik Xenograftlarla Tam Kök Aort Kapak Replasmanı

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

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

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer tomography measurements. The indications and limitations of this technique, as well as its alternatives, are discussed.

The goal of this protocol is to describe in detail the technique of minimally invasive aortic valve replacement through a right anterior mini-thoracotomy and central aortic cannulation. This technique can potentially enhance patients&#39; comfort and, by reducing post-operative morbidity, promote lowering the length of stay and global costs.

Teknik ve en az düzeyde erişim aort kapak replasmanı için hemen ön Mini Torakotomi hasta seçimi kriterleri

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

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 ...

Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model

Transcatheter pulmonary valve replacement has been established as a viable alternative approach for patients suffering from right ventricular outflow tract or bioprosthetic valve dysfunction, with excellent early and late clinical outcomes. However, clinical challenges such as stented heart valve deterioration, coronary occlusion, endocarditis, and other complications must be addressed for lifetime application, particularly in pediatric patients. To facilitate the development of a lifelong solution for patients, transcatheter autologous pulmonary valve replacement was performed in an adult sheep model. The autologous pericardium was harvested from the sheep via left anterolateral minithoracotomy under general anesthesia with ventilation. The pericardium was placed on a 3D shaping heart valve model for non-toxic cross-linking for 2 days and 21 h. Intracardiac echocardiography (ICE) and angiography were performed to assess the position, morphology, function, and dimensions of the native pulmonary valve (NPV). After trimming, the crosslinked pericardium was sewn onto a self-expandable Nitinol stent and crimped into a self-designed delivery system. The autologous pulmonary valve (APV) was implanted at the NPV position via left jugular vein catheterization. ICE and angiography were repeated to evaluate the position, morphology, function, and dimensions of the APV. An APV was successfully implanted in&#160;sheep J. In this paper, sheep J was selected to obtain representative results. A 30 mm APV with a Nitinol stent was accurately implanted at the NPV position without any significant hemodynamic change. There was no paravalvular leak, no new pulmonary valve insufficiency, or stented pulmonary valve migration. This study demonstrated the feasibility and safety, in a long-time follow-up, of developing an APV for implantation at the NPV position with a self-expandable Nitinol stent via jugular vein catheterization in an adult sheep model.

This study demonstrates the feasibility and safety of developing an autologous pulmonary valve for implantation at the native pulmonary valve position by using a self-expandable Nitinol stent in an adult sheep model. This is a step toward developing transcatheter pulmonary valve replacement for patients with right ventricular outflow tract dysfunction.

Yetişkin Bir Koyun Modelinde Otolog Perikarddan Transkateter Pulmoner Kapak Replasmanı

Transcatheter pulmonary valve replacement has been established as a viable alternative approach for patients suffering from right ventricular outflow ...

A Modified Technique for Transverse Aortic Constriction in Mice

Transverse aortic constriction (TAC) is a frequently used surgery in research regarding heart failure and cardiac hypertrophy based on the formation of pressure overload in mouse models. The main challenge of this procedure is to clearly visualize the transverse aortic arch and precisely band the target vessel. Classical approaches perform a partial thoracotomy to expose the transverse aortic arch. However, it is an open-chest model that causes a rather large surgical trauma and requires a ventilator during the surgery. To prevent unnecessary trauma and simplify the operating procedure, the aortic arch is approached via the proximal proportion of the sternum, reaching and binding the target vessel using a small self-made retractor that contains a snare. This procedure can be conducted without entering the pleura cavity and does not need a ventilator or microsurgical operation, which leaves the mice with physiological breathing patterns, simplifies the procedure, and significantly reduces operation time. Due to the less invasive approach and less operation time, mice can undergo fewer stress reactions and recover rapidly.

The present protocol describes a modified and simplified technique with a minimally invasive transverse aortic constriction (TAC) procedure using a self-made retractor. This procedure can be conducted without a ventilator or microscope and introduces pressure overload, eventually leading to cardiac hypertrophy or heart failure.

Farelerde Transvers Aort Daralması için Modifiye Bir Teknik

Transverse aortic constriction (TAC) is a frequently used surgery in research regarding heart failure and cardiac hypertrophy based on the formation of ...

Biyoloji

Novel and Innovative Hybrid Technique for Type A Aortic Dissection

Acute Stanford type A aortic dissection (TAAD) is a surgical emergency characterized by a high mortality rate and numerous complications. In the treatment of TAAD, the timing of surgery and the choice of surgical procedure are of paramount importance. Open total aortic arch reconstruction remains the gold standard for aortic arch surgery and is one of the most challenging procedures. However, this approach is invasive, relatively lengthy, and associated with substantial bleeding, which necessitates high levels of operator skill and carries the risk of multiple complications, particularly neurological ones. This report describes a novel hybrid procedure named Open Ascending Aorta Replacement Combined with Fenestrated Total Aortic Arch Stenting. A case was selected in which the lesion did not involve the aortic arch, at least on the greater curvature side of the arch. Ascending aortic replacement was performed, followed by arch intervention with self-modified stent grafts to preserve the aortic arch native branches. This approach allows for a rapid simplification of the procedure, avoids deep hypothermia or circulatory arrest associated with conventional open surgery, and mitigates neurological complications.

The protocol describes ascending aortic replacement combined with endovascular coverage of the entire aortic arch with a fenestrated stent graft in a patient with acute type A aortic dissection in the absence of a tear in the aortic arch.

Tip A Aort Diseksiyonu için Yeni ve Yenilikçi Hibrit Teknik

Acute Stanford type A aortic dissection (TAAD) is a surgical emergency characterized by a high mortality rate and numerous complications. In the treatment ...