Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis

Hoffmann, Carson; Heiner, Jacob A.; Nguyen, Tom C.

doi:10.21037/acs.2017.09.02

Cited by 9 publications

(9 citation statements)

References 33 publications

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“…It is associated with longer aortic crossclamp and cardiopulmonary bypass (CPB) times; however, the use of rapid deployment valves can circumvent this. Studies comparing TAVI and miniAVR demonstrate decreased postoperative mortality, valvular regurgitation, and incidence of stroke in the miniAVR cohorts [51].…”

Section: Discussionmentioning

confidence: 94%

“…Meanwhile, the surgical approach has improved and evolved to a reduction in surgical aggression. TAVI and minimally invasive aortic valve replacement [51] have become alternatives to surgical aortic valve replacement via median sternotomy (SAVR) to treat severe aortic stenosis (AS). Despite increased interest and utilization, few studies have directly compared TAVI and miniAVR.…”

Section: Discussionmentioning

confidence: 99%

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Current Management of Severe Aortic Stenosis in Intermediate Risk Patients

Leal¹,

Sánchez-Valenzuela²,

Bustamante‐Munguira³

2019

Aortic Stenosis - Current Perspectives

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The management of aortic stenosis has improved and evolved to a reduction in surgical aggression. Nowadays, patients with intermediate risk are in the frontier of transcatheter aortic valve implantation (TAVI) and aortic valve replacement (AVR). Our goal is to update the treatment of severe aortic stenosis in those patients through a research of the recent literature, in order to analyze the current treatment options and their results. This cohort of patients has two therapeutic options, surgical AVR or TAVI, and the decision pathway goes through the accurate interpretation of all data by the Heart Team. It is clear that both strategies will be the cornerstones in the modern AVR era, but the situations in which to apply each strategy have not yet been clearly delineated. More studies are needed to compare TAVI and miniAVR in low-and intermediate-risk patients. However, the current practice guidelines give a good pathway to choose the adequate therapeutic option in each individual case.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Current Management of Severe Aortic Stenosis in Intermediate Risk Patients

Leal¹,

Sánchez-Valenzuela²,

Bustamante‐Munguira³

2019

Aortic Stenosis - Current Perspectives

View full text Add to dashboard Cite

show abstract

“…Furthermore, Terwelp et al showed TAVR was associated with an increased risk of stroke but a reduced rate of atrial fibrillation compared to mini‐AVR. However, it is important to note that the patients undergoing TAVR tend to be at high‐risk, while patients assigned to mini‐AVR have been low‐risk . Therefore, it is difficult to draw meaningful conclusions even with propensity‐matched studies.…”

Section: Discussionmentioning

confidence: 99%

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

et al. 2019

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Introduction: Cor-Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims to review the safety and efficacy of automated fasteners in heart valve surgeries. Method: Specific searches were conducted via online medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019. Longitudinal studies were included that provided operative parameters. Results: The initial literature search identified 3773 articles, but only eight met the inclusion criteria and were used for analysis: four studies related to aortic valve replacement (AVR), four related to mitral valve (MV) intervention (total n = 810). The meta-analysis revealed the significantly shorter aortic cross-clamp time in the Cor-knot group compared to manual tying, both in AVR and MV surgeries (P < .05). Cardiopulmonary bypass time was significantly shorter in the Cor-knot group when analyzing studies in MV surgery (weighted mean difference [WMD]: 110.0; 95% confidence interval: 12.3-207.7; P = .027) The use of Cor-Knot did not increase the risk of permanent pacemaker implantation, paravalvular leak, and 30-day mortality. The majority of studies reported no change in the length of intensive unit care and total hospital stay. Conclusion:We confirmed that the majority of existing literatures indicated the safety and intraoperative efficacy with automated fastener application. Nevertheless, there is currently no evidence to support automated fastened sutures can translate its intraoperative advantages to improved patient outcome. K E Y W O R D S aortic, automated fastener, clinical review, cor-knot, heart valves, mitral 1 | BACKGROUND Surgery for valvular heart disease is well-established and remains a superior treatment option for many valvular pathologies in many patient groups. Both replacement (with prosthetic valves) and repair Abbreviations: AS, aortic stenosis; AVR, aortic valve replacement; AXT, aortic cross-clamp time; CPB, cardiopulmonary bypass time; ICU, intensive care unit; LV, left ventricular; Mini-AVR, minimally invasive aortic valve replacement; Mini-MV repair, minimally invasive mitral valve repair; MR, mitral regurgitation; MV, mitral valve; PPI, permanent pacemaker implantation; PVL, paravalvular leak; TAVR, transcatheter aortic valve replacement. Lueh Chien and M. Yousuf Salmasi are Joint first authors.

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“…For the therapeutic choice between TAVI, mini-AVR and CAVR, a dedicated heart team assesses each patient based on previous cardiologic history and baseline characteristics, calculate the risk of surgery, evaluate the feasibility of TAVI or surgery, and local experience. TAVI is associated with increased pacemaker implantation, vascular complications and paravalvular leakage [31]. For mini-AVR and CAVR these complications are less common.…”

Section: Discussionmentioning

confidence: 99%

Minimal invasive aortic valve replacement: associations of radiological assessments with procedure complexity

Boti

Hindori

Schade

et al. 2019

J Cardiothorac Surg

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Objectives: Limited aortic annulus exposure during minimal invasive aortic valve replacement (mini-AVR) proves to be challenging and contributes to procedure complexity, resulting in longer procedure times. New innovations like sutureless valves have been introduced to reduce procedure complexity. Additionally, preoperative imaging could also contribute to reducing procedure times. Therefore, we hypothesize that Computed Tomography (CT)-image based measurements are associated with mini-AVR complexity. Methods: One hundred patients who underwent a mini-sternotomy and had a preoperative CT scan were included. With a CT-based mini-AVR planning tool, we measured access distance, access angle, annulus dimensions, and calcium volume. The associations of these measurements with cardiopulmonary bypass (CPB) time and aortic cross-clamp (AoX) time were assessed using univariable and multivariable regression models. In the multivariable models, these measurements were adjusted for age and suture technique. Results: In the univariable regression models, calcium volume and annulus dimensions were associated with longer CPB and AoX time. After adjusting for age and suture technique, increasing calcium volume was still associated with longer CPB (adjusted β-coefficient 0.002, 95%-CI (0.005, 0.019), p-value = 0.002) and AoX time (adjusted βcoefficient 0.010, 95%-CI (0.004, 0.016), p-value = 0.002). However, after adjusting for these confounders, the association between annulus dimensions and procedure times lost statistical significance. Conclusion: Increase in calcium volume are associated with longer CPB and AoX times, with age and sutureless valve implantation as independent confounders. In contrast to previous studies, access angle was not associated with procedure complexity.

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Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis

Cited by 9 publications

References 33 publications

Current Management of Severe Aortic Stenosis in Intermediate Risk Patients

Current Management of Severe Aortic Stenosis in Intermediate Risk Patients

What is the safety and efficacy of the use of automated fastener in heart valve surgery?

Minimal invasive aortic valve replacement: associations of radiological assessments with procedure complexity

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