Treatment of degenerative aortic stenosis has been transformed by transcatheter aortic valve implantation (TAVI) over the past 10–15 years. The success of various technologies has led operators to attempt to broaden the indications, and many patients with native valve aortic regurgitation have been treated ‘off label’ with similar techniques. However, the alterations in the structure of the valve complex in pure native aortic regurgitation are distinct to those in degenerative aortic stenosis, and there are unique challenges to be overcome by percutaneous valves. Nevertheless some promise has been shown with both non-dedicated and dedicated devices. In this article, the authors explore some of these challenges and review the current evidence base for TAVI for aortic regurgitation.

Fat grafting has become a well-accepted surgical modality to correct soft tissue facial defects and asymmetries with overall good results. Several techniques have been reported over the last few years to assist in improving accurate evaluation of facial defects and in the preoperative planning of the reconstruction. Such techniques include among others, computer tomography, three-dimensional (3D) photogrammetry, high resolution ultrasound, and 3D laser scanning. There are advantages and disadvantages for each technique. With the rapid advance of 3D technologies that have become readily available to clinicians, new clinical applications continually emerge to guide and facilitate reconstructive procedures. The authors explored the possibility of fabricating a 3D printed surgical guide to define volume differences for soft tissue reconstruction in patients with facial asymmetry. The model was developed through the authors’ virtual surgical simulation and planning system that consists of computer-assisted design (CAD) and 3D printing (3DP). Three-dimensional volumetric scans of patients’ faces were analyzed with computer-aided design to quantify areas of facial asymmetry. Surgical guides with containers defining volumetric differences were fabricated using 3D printing to identify and quantify areas of soft tissue deficiency. The 3D printed patient-specific, guides were sterilized and used by the surgeon intraoperatively to accurately mark the areas of soft deficiency. Thus, facial symmetry was achieved by fat grafting the predetermined volume differences defined in the surgical guides. A postop mask was used by the surgeon at the end of the procedure and during follow-up clinic visit to verify and evaluate accurate fat grafting placement as well as to determine areas where to add volume if needed. This paper details the rational for the authors’ approach, outlines the technical planning and fabrication process of these patient-specific custom surgical guides with quantified volumetric containers and their intraoperative use by the surgeon. Despite the authors’ limited experience we conclude that the authors’ technique offer surgeons a precise means for accurate volumetric reconstruction of facial asymmetry.

No abstract

hope in his patients. Dr Jackson embodied the Mayo Clinic values of respect, integrity, teamwork, and compassion. His legacy not only enriched the history of Mayo Clinic, but changed the history and future of plastic surgery.Dr William J. Mayo stated, "The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.'' Dr Jackson truly integrated multidisciplinary clinical practice to optimize patient needs, which was particularly exemplified in his complex facial reconstructions. He also advanced craniofacial surgery with procedures for skull base tumors, which had not previously been attempted and attracted patients from around the world for secondary cleft revisions.As Chair of Plastic Surgery at Mayo Clinic, I am honored to serve in the role that Dr Jackson served in nearly 45 years ago. His legacy lives on and his innovative spirit and tremendous aura live on in our division and institution. I reflect on a couple of ties I have to Dr Jackson that were mere coincidence but enjoyable to reminisce on. In 2018, the Department of Plastic Surgery in Uppsala, Sweden created a Visiting Professorship to honor the founder of the department the legendary Dr Skoog who happened to be one of Dr Jackson's three main mentors in plastic surgery, I was honored to be invited as their first Tord Skoog Visiting Professor. Also, I discovered recently Dr Jackson's strong relationship to Peru and the humanitarian work he did there and cannot help but find a coincidental connection with our cleft and craniofacial trips to Peru totally over 18 weeks over the last 14 years.After several decades, Dr Jackson's name is mentioned often and his contributions are routinely sited and admired. Dr Uldis Bite and I Co-Direct the Cleft and Craniofacial Clinic that Dr Jackson started so many years ago. His teaching, team structure, leadership, innovation and collegiality continue to motivate and inspire us. We have since formed several other multidisciplinary teams including our facial reanimation team and face transplant team. His groundbreaking procedures and his incessant passion to help others were a true inspiration for us to perform a near total face transplant on our patient Mr Andrew Sandness. When planning for our facial transplantation, we invoked the same principles of multidisciplinary team-based care, which includes not only surgeons and physicians, but also psychiatrists, social workers, nurses, anaplastologists, surgical technicians, administrators, ethicists, biomedical engineers, transplant coordinators, pharmacists, dieticians, photographers, videographers, radiologists, and many others.We will always remember Dr Ian T. Jackson and hold him dear to our hearts. Thank you Dr Jackson for your selfless nature and for helping so many human beings around the world, we admire you and we love you. From your Mayo Clinic Family.

No abstract

No abstract

No abstract

No abstract