Name: full-root aortic valve replacement by stentless aortic xenografts in patients with small aortic roots
Uploaded: 2017-05-21T14:00:00
Description: Watch this Scientific Journal Video about Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots at JoVE.com

这项工作得到了瑞士心血管基金会向RT提供的资助。

该议定书遵循人类研究伦理委员会的机构准则。 1.预选患者<ol><li>使用术前超声心动图，确定估计主动脉环直径小于20 mm的患者。请注意，在严重钙化的主动脉瓣和瓣膜中，术前超声心动图有时可能会误导。 </li><li>从这些患者中选择身体表面积大于1.6平方米的亚组。 </li><li>在阀门制造商提供的图表上验证，标记为19 mm的支架式心包主动脉瓣置换的有效孔面积为1.28 cm 2</sup...

<ol>
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C., Albert, A., Dalladaku, F., Rosendahl, U., Ennker, J., Florath, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Midterm+outcome+after+aortic+root+replacement+with+stentless+porcine+bioprostheses.">Midterm outcome after aortic root replacement with stentless porcine bioprostheses.</a> Eur. J Cardio-thorac. Surg. 40 (2), 429-434 (2011).</li><li>Tavakoli, 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=Full-root+aortic+valve+replacement+with+stentless+xenograft+achieves+superior+regression+of+left+ventricular+hypertrophy+compared+to+pericardial+stented+aortic+valves.">Full-root aortic valve replacement with stentless xenograft achieves superior regression of left ventricular hypertrophy compared to pericardial stented aortic valves.</a> J. Cardiothorac. Surg. 10, 15 (2015).</li><li>Kon, N. D., Cordell, A. R., Adair, S. M., Dobbins, J. E., Kitzman, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aortic+root+replacement+with+the+Freestyle+stentless+porcine+aortic+root+bioprosthesis.">Aortic root replacement with the Freestyle stentless porcine aortic root bioprosthesis.</a> Ann. Thorac. Surg. 67 (6), 1609-1616 (1999).</li><li>Dapunt, O. 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=Stentless+full-root+bioprosthesis+in+surgery+for+complex+aortic+valve-ascending+aortic+disease:+a+single+center+experience+of+over+300+patients.">Stentless full-root bioprosthesis in surgery for complex aortic valve-ascending aortic disease: a single center experience of over 300 patients.</a> Eur. J. Cardiothorac. Surg. 33 (4), 554-559 (2008).</li><li>Saxena, A., Dinh, D., Smith, J. A., Reid, C. 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<html>本研究报告了具有小主动脉根部病人的无支架主动脉异种移植物全根主动脉瓣置换术的详细描述。早期发病率和死亡率非常低，与其他报告相比有优势7 。重度钙化冠状动脉口腔构成对这种技术的解剖限制。这种技术的另一个缺点是由总体状况差的患者表现出来，不能耐受较长的手术时间。在这些情况下，标准的支架置入的心包主动脉瓣置换术，有或没有主动脉根部扩大应?...

65岁以上的患者推荐使用生物主动脉瓣置换术1 。在小主动脉根部的患者中，植入根据制造商提供的标签尺寸的支架生物瓣膜替代物可能不符合功能需求。在这种情况下，Rahimtoola首先描述了假体和患者不匹配（PPM），如下所示：“ 插入患者后有效的假体瓣膜面积小于正常人体瓣膜 ” 2 时，可以认为不匹配存在 。瓣膜假体的有效孔口面积与患者的身体尺寸有关，并且更常见于患者的体表面积。太小的人工瓣膜的血流动力学结果是异常高的跨瓣叶梯度3 。已经表明，跨瓣度梯度与效应之间的关系指向体表面积（EOAI）的孔口面积为曲线，当指数的EOA小于0.8至0.9cm 2 / m 2时，梯度呈指数增长。在这种关系的基础上，小于0.85cm 2 / m 2的EOAI通常被认为是主动脉位置4中PPM的阈值。 PPM对早期和晚期临床结果的影响是有争议的。然而，据报道，PPM负面影响左心室肥大的退化，从而影响左心室功能的正常化和症状缓解4 。持续的左心室肥大与心律失常和心源性猝死的风险增加有关5 。 因此建议尽量避免PPM 4 。在使用生物体计划的主动脉瓣置换可预测的PPM的情况下选择是：1）接受患者的合并症时植入支架置入的心包瓣膜造成的PPM，禁止更技术要求较高的手术技术植入较大的假体，2）扩大主动脉根部以适应更大的支架置换阀6或3）植入无支架生物瓣膜7或同种移植物8 。 据报道主动脉根部肿大增加围手术期出血，需要重新切开胸腔，并增加早期死亡率9 。有经验的外科医生植入时，主动脉同种异体移植物可能具有优异的血液动力学特征和良好的长期疗效。然而，它们有限的可用性和加速的钙化率使得主动脉同种异体移植物不如其对应的生物瓣膜替代物，猪无支架主动脉移植物10 。 同种异体移植物的短缺和缺点促使替代生物瓣膜替代品的构想和发展。为此，将无支架的主动脉异种移植物引入临床实践11 。一方面，由于消除麻烦的缝合环，无支架主动脉异种移植物可以再现同种移植物的血液动力学优势。另一方面，由于应用抗钙化技术，无支架主动脉异种移植物的耐久性已被优化，以匹配甚至超过同种移植物的寿命11 。无支架主动脉异种移植物的血流动力学优势完全通过全根植入获得12 。与亚冠状和根夹入技术相比，全根植入将无支架主动脉异种移植物放置在主动脉环的顶部，而不在其内。这个事实和推翻了全根植入技术的理由，从而实现了无支架阀替代品的最大内功能直径。此外，与瓣膜传单一起保存的瓦萨尔瓦鼻窦有利于更多的生理开闭运动，从而延长传单的预期寿命。这一优势进一步有助于改善长期成果12 。 然而，对增加的出血潜力和冠状动脉口吻合的可能扭曲的担忧防止了许多心脏外科医生从具有支架的生物瓣膜的经典主动脉瓣置换转变为以全根替代为代表的技术要求更高的方法，无支架主动脉异种移植物。 鉴于无支架主动脉异种移植物的潜在血液动力学优势，我们采用了全身性t植入以避免PPO在需要主动脉瓣置换的小主动脉根部的患者（ 表1 ）。在这些患者中，目的是为新植入的主动脉瓣获得大于0.85cm 2 / m 2的预计EOAI。该意图是基于Pibarot及其同事的报告显示，具有小于0.85 cm 2 / m 2的预计EOAI的瓣膜替代品的不可接受的高跨度梯度，随后症状的不完全缓解以及不良结局的持续风险3，4 。在手术后超声心动图初步鉴定主动脉瓣环直径小于20 mm的成年患者后，进一步选择患者身体表面积大于1.6平方米。在这一亚组患者中，植入19 mm支架的心包主动脉瓣（EOA：1.28 cm 2 </sup&gt;）将导致小于0.85cm 2 / m 2的预计EOAI。在该方案中，这些患者是全根植入无支架主动脉异种移植物的候选者。最终决定是在手术切除主动脉瓣后进行的。如果用于支架式心包主动脉瓣的19 mm阀门尺寸调节器通过主动脉瓣环过紧，患者血液动力学稳定并能耐受更长时间的手术，则可进行全根植入无支架主动脉异种移植。 对于无支架的主动脉异种移植物，我们可以互换使用两种市售的瓣膜替代物（详见材料表 ）。两个阀均采用主动脉瓣主动脉根部。它们使用低压（0-2 mmHg）固定过程制备，具有抗钙化（ 如 XenoLogiX）治疗一个瓣膜和α氨基油酸（AOA）抗ca对另一方进行化疗。在那些用于支架式心包瓣膜的19 mm尺寸调整器通过主动脉环过紧的患者中，主动脉瓣环中较好的无支架主动脉异种移植物的23 mm尺寸测量仪表示23 mm的无支架主动脉异种移植物尺寸为被选中。该方案详细描述了全根植入无支架主动脉异种移植物的技术，重点是近端缝合线和冠状动脉吻合的管理。讨论这种技术和替代选项的局限性。

<table border="0" cellpadding="0" cellspacing="0" width="761">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:368px;">Heart surgery infrastructure:</td>
			<td style="width:163px;"></td>
			<td style="width:151px;"></td>
			<td style="width:80px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Heart Lung Machine</td>
			<td>Stockert</td>
			<td>SIII</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">EOPA 24Fr. arterial cannula</td>
			<td>Medtronic</td>
			<td>77624</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Atrial caval venous cannula 34/48Fr.</td>
			<td>Medtronic</td>
			<td>93448</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">LV vent catheter 17Fr.</td>
			<td>Edwards</td>
			<td>E061</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Antegrade 9Fr. cardioplegia cannula</td>
			<td>Edwards</td>
			<td>AR012V</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Retrograde 14Fr. cardioplegia cannula&#160;</td>
			<td>Edwards</td>
			<td>NPC014&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Coronary artery ostial cannula 90&#176;</td>
			<td>Medtronic</td>
			<td>30155</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Coronary artery ostial cannula 45&#176;</td>
			<td>Medtronic</td>
			<td>30255</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Valve subsitutes:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Stentless aortic xenograft Prima Plus 23mm</td>
			<td>Edwards</td>
			<td>2500P-23</td>
			<td>anti-calcification XenoLogiX treatment</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Stentless aortic xenograft Sizer 23mm</td>
			<td>Edwards</td>
			<td>1170</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Stentless aortic xenograft Freestyle 23 mm</td>
			<td>Medtronic</td>
			<td>FR995-23</td>
			<td>alpha amino oleic acid (AOA) anti-calcification treatment</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Stentless aortic xenograft Sizer 23mm</td>
			<td>Medtronic</td>
			<td>7900</td>
			<td></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;">Electrocautery</td>
			<td>Covidien</td>
			<td>Force FXTM</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Sutures:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Polypropylene 4/0</td>
			<td>Ethicon</td>
			<td>8871H</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Polypropylene 5/0</td>
			<td>Ethicon</td>
			<td>8870H</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Polypropylene 6/0</td>
			<td>Ethicon</td>
			<td>EH7400H</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Braided polyesther 2/0 ligature with polybutylate coating&#160;</td>
			<td>Ethicon</td>
			<td>X305H</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Micro knife Sharpoint&#160;</td>
			<td>TYCO Healthcare PTY&#160;</td>
			<td>78-6900</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Drugs:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Midazolam</td>
			<td>Roche Pharma</td>
			<td>N05CD08</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Rocuronium</td>
			<td>MSD Merck Sharp &#38; Dohme&#160;</td>
			<td>M03AC09</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Propofol</td>
			<td>Fresenius Kabi</td>
			<td>N01AX10</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Fentanil</td>
			<td>Actavis</td>
			<td>N01AH01</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Heparin</td>
			<td>Braun</td>
			<td>B01AB01</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Protamin</td>
			<td>MEDA Pharmaceutical</td>
			<td>V03AB14</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Instruments:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Cooley vascular aortic clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC40810-16</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Dissection forceps Carpentier</td>
			<td>Delacroix-Chevalier</td>
			<td>DC13110-28&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Scissors Metzenbaum</td>
			<td>Delacroix-Chevalier</td>
			<td>B351751</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Needle holder Ryder</td>
			<td>Delacroix-Chevalier</td>
			<td>DC51130-20&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Dissection forceps DeBakey</td>
			<td>Delacroix-Chevalier</td>
			<td>DC12000-21&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Micro needle holder Jacobson</td>
			<td>Delacroix-Chevalier</td>
			<td>DC50002-21&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Micro scisors Jacobson</td>
			<td>Delacroix-Chevalier</td>
			<td>DC20057-21&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Lung retractor</td>
			<td>Delacroix-Chevalier</td>
			<td>B803990</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Allis clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC45907-25&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">O&#8217;Shaugnessy Dissector</td>
			<td>Delacroix-Chevalier</td>
			<td>B60650</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">18 blade knife</td>
			<td>Delacroix-Chevalier</td>
			<td>B130180</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Leriche haemostatic clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>B86555</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Data analysis:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Mann-Whitney and Chi-square tests</td>
			<td>GraphPad</td>
			<td>Prism 7</td>
			<td></td>
		</tr>
	</tbody>
</table>

full-root aortic valve replacement by stentless aortic xenografts in patients with small aortic roots

在需要主动脉瓣置换术的小型主动脉根部患者中，采用生物瓣膜置换术，支架置入的心包瓣膜的植入可能不能满足功能需要。植入太小的支架式心包瓣膜，导致指向小于0.85cm 2 / m 2的体表面积的有效孔面积被认为是假体 - 患者不匹配（PPM）。 PPM负面影响左心室肥大的退化，从而影响左心室功能的正常化和症状的缓解。持续的左心室肥大与心律失常和心源性猝死风险增加有关。在可预测的PPM的情况下，有三个选择：1）接受患者的合并症时植入支架置入的心包瓣膜造成的PPM，禁止植入较大假体的技术要求更高的手术技术，2）放大主动脉根部容纳更大的支架置换阀，或3）植入无支架生物瓣膜或同种移植物。与具有支架式心包瓣膜的经典主动脉瓣置换相比，全根植入无支架主动脉异种移植物提供了在给定患者中植入3-4mm更大的瓣膜的可能性，从而允许跨瓣膜梯度显着降低。然而，一些心脏外科医生不愿意将具有支架的心包瓣膜的经典主动脉瓣置换转换为更无技术上具有挑战性的全根植入无支架主动脉异种移植物。鉴于无支架主动脉异种移植物的潜在血液动力学优势，我们采用全根植入术，以避免需要主动脉瓣置换的小主动脉根部病人的PPM。在这里，我们详细描述了全根植入无支架主动脉异种移植物的技术，重点是近端缝合线的管理冠状动脉吻合术。讨论这种技术和替代选项的局限性。

统计分析植入的无支架主动脉异种移植物（23毫米）的体表面积（EOAI，cm 2 / m 2 ）的预计有效孔面积的值表示为平均值±SD，并与计算出的4 mm较小的支架式心包瓣膜的EOAI值进行比较即 19 mm），使用非参数Mann Whitney检验。在表2中，使用非参数Mann Whitney检验和通过卡方检验的分类变量来比较连续变量。使用市?...

Watch this Scientific Journal Video about Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots at JoVE.com

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

通过无支架主动脉异种移植的全根主动脉瓣置换术是小主动脉根部病人的可行选择。我们描述了一种全根植入无支架主动脉异种移植物的技术，重点是近端缝合线和冠状动脉吻合的管理，并讨论其局限性和替代选择。

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 ...

The overall goal of this surgical procedure is to provide a reliable and reproducible full root implantation of stentless aortic xenografts for patients with small aortic roots undergoing aortic valve replacements. The main advantage of this technique is that it is an excellent option to avoid prosthesis patient mismatch in patients who have a small aortic annulus and who are undergoing an aortic valve replacement. This method can also help answer key questions regarding re-implantation of coronary arteries, such as during aortic root surgery.After surgically accessing the heart through a median sternum and installing a cardiopulmonary bypass, prepare the aortic root for implantation. In summary, use forceps and a number 18 blade to enlarge the aortic opening and transect the aorta with Metzenbaum scissors. Then, verify the presence of the right coronary ostium and the left coronary ostium.Next, excise the right coronary leaflet, the non-coronary leaflet, and the left coronary leaflet. Finish the preparation with a perpendicular incision from the top of the non-coronary Valsalva sinus wall down to its base. Now, start the proximal anastomosis.After placing stay sutures above each aortic commissure, start a suture from the outer aspect of the xenograft to the inner aspect, and pass the stitch into the nadir of the left coronary sinus. Place the next stitch two millimeters to the left of the first. Then, with the aid of an assistant, continue the running suture up to the commissure between the coronary sinuses.Now, start a second suture starting at the aortic annulus two millimeters to the right of the first suture. From the ventricle, pass these stitches outward. Next, place a third suture starting two millimeters to the side of the second suture starting at the sewing ring at the xenograft.Run the suture to the commissure between the right sinus and non-coronary sinus and put both ends of the third suture on traction. Now, place a fourth suture at the commissure between the right and non-coronary sinus and run it to the middle of the non-coronary sinus. Now, run a fifth suture from the middle of the non-coronary sinus to the commissure between the non-coronary sinus and the left coronary sinus.Finally, run the last suture from the end of the fifth suture to the end of the first running suture. Once placed, slowly pull the sixth suture until the graft is tight against the aortic annulus;and then, tie the sutures together. Before proceeding, clean out the region around the proximal suture line and coronary ostia.Inspect the anastomosis for gaps between the bites. Begin the coronary anastomoses by reconnecting the left coronary ostium to the left coronary neo-ostium of the graft. Place the first stitch of a 6/0 polypropylene running suture at the deepest point of the left coronary neo-ostium from the inside out, and pass this stitch to the deepest point of the left coronary ostium from the outside in.Place the second stitch to the right of the first. Now, continue the suture into the left coronary neo-ostium of the graft and then into the left coronary ostium of the patient. Then, tie the two sutures together.Next, using a scalpel, create a right coronary neo-ostium in the graft by excising the ligated right coronary of the graft and enlarging the opening horizontally towards the commissure between the right sinus and the non-coronary sinus of the graft. Then, place a running suture at the left end of the lower ridge of the right coronary ostium. Stitch from the inside out and pass the stitch through the neo-ostium, also at the left end of the lower ridge of the right coronary.Then, pull the tissues together. Pass the second stitch to the right of the first and bring the suture to the middle of the right ridge of the right coronary anastomosis. Now, continue stitching from the left, moving from the outside to the inside of the patient's tissue and from the inside to the outside of the graft tissue.Once the running suture is completed, tie the ends together. Lastly, put two coronary artery ostial cannulas in place, one into the left coronary ostium and the other into the right coronary ostium for repeat antegrade cardioplegia. Begin the distal anastomosis with a 5/0 polypropylene running suture from the left end of the lower rim and continue it to the middle of the right rim.Place stitches at regular two-millimeter intervals from the inside out on the graft tissue and from the outside in on the patient's tissue. Now, continue with the left end of the suture placing equidistant stitches on the anterior aspect of the anastomosis from the outside in on the graft and from the inside out on the patient. Once closed, tie together the suture ends.Now, slowly remove the aortic cross-clamp under gentle aspiration of the left ventricular vent. Then, remove the lung retractor on the right ventricle. The effective orifice area index is determined from the patient's body surface area and can be used to predict prosthesis patient mismatches.In patient's with small aortic roots, a 19-millimeter stented pericardial valve would result in mismatches. However, by implanting stentless aortic xenografts, the EOAI becomes significantly greater;and mismatch problems are not expected. Surgical data of stentless aortic xenograft implantation in small aortic roots was compared with similar data reported for stented pericardial valves.Cross-clamp cardiopulmonary bypass and operative times were all longer using the xenografts;however, 30-day morbidity and mortality measures were equally excellent. While attempting this procedure, it is important to remember to sufficiently mobilize the coronary ostium. Don't forget that full root implantation of stentless aortic xenografts can be extremely delicate and precautions, such as even distribution of tension on the proximal anastomosis by multiple semi-continuous sutures, should always be taken.

Research

JoVE Journal

Medicine

Orthotopic Aortic Transplantation in Mice for the Study of Vascular Disease

原位主动脉瓣移植在小鼠血管疾病的研究

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

科研

医学

A New Murine Model of Endovascular Aortic Aneurysm Repair

一种新的小鼠模型主动脉瘤腔内修复

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

Reproducible Arterial Denudation Injury by Infrarenal Abdominal Aortic Clamping in a Murine Model

重复性的动脉剥脱损伤腹主动脉阻断在小鼠模型

Percutaneous vascular interventions uniformly result in arterial denudation injuries that subsequently lead to thrombosis and restenosis. These ...

Minimally Invasive Transverse Aortic Constriction in Mice

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 ...

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

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 ...

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

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

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

经导管主动脉瓣植入术中 X 线透视 3D CT 血管造影的改进与影像融合

The fusion of 3D anatomical models derived from high-fidelity pre-interventional computed tomography angiography (CTA), and x-ray (XR) fluoroscopy to ...

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents

研究左心室反向改造由主动脉脱体在啮齿动物

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, ...

Porcine Model of Infrarenal Abdominal Aortic Aneurysm

肾上腺腹动脉瘤的猪模型

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal ...