8. Nov, 2018 Athens Clossroad 2018, Athens GREEK
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1 8. Nov, 2018 Athens Clossroad 2018, Athens GREEK Stent Less Bio prosthesis Aortic Valve replacement with Minimally Invasive Approach ~ Indication for the 1 st Surgical Aortic Valve Treatment Considering TAVI Generation ~ ISEIKAI General Hospital (Osaka, JAPAN) Cardiovascular Center Cardiovascular Surgery Japan Advanced Institute of Science and Technology (JAIST) Kanazawa city, Ishikawa Toshimi UJIIE MD, PhD
2 JAPAN Our City Osaka Osaka Prefecture : 8,880,000 people Osaka City : 2.7 million people Osaka Prefecture
3 Osaka city, Osaka Prefecture, JAPAN Our Hospital
4 Japan Advanced Institute of Science and Technology JAIST : Kanazawa city, Ishikawa Prefecture, JAPAN Visiting Professor and Industrial Advisor
5 Kanazawa city, Ishikawa Prefecture, JAPAN
6 University Medical Center Ljubljana ( SLOVENIA) Cardiovascular Surgery (2000~2004, 2011~2012) with Prof. Gersak BORUT
7 Ljubljana SLOVENIA Ljubljana
8 University Medical Center Ljubljana ( SLOVENIA)
9 University Medical Center Ljubljana ( SLOVENIA)
10 University Medical Center Ljubljana ( SLOVENIA) Cardiovascular Surgery (2000~2004, 2011~2012) with Prof. Gersak BORUT
11 OFF-PUMP CABG& 極小切開 (3cm) 僧帽弁置換 with Heartport System
12 Minimally Invasive MVR(MICS-MVR)
13
14 Stent-Less Aortic Prosthesis Valve Using Approval from 2016 in JAPAN Specifically designed for patients requiring superior hemodynamic performance
15 University Medical Center Ljubljana ( SLOVENIA) Cardiovascular Surgery (2000~2004, 2011~2012) with Prof. Gersak BORUT
16 Suture-Less Aortic Prosthesis Valve Perceval (2011~,Europe) In JAPAN Using Approval from..?
17 Suture-Less Aortic Prosthesis Valve Perceval In JAPAN NOT YET! Strong Sternum Fixation
18 Stent-Less Aortic Prosthesis Valve Freedom SOLO (2000~2004) Suture-Less Aortic Prosthesis Valve Perceval S (2011~2012)
19 Device Lag Commercially available moment Big difference between JAPAN and Europe or America
20 Cor-Knot
21 Cor-Knot Not Yet in Japan(2018)
22 Device Lag Commercially available moment Big difference between JAPAN and Europe or America
23 BACK GROUND 1. Since 2015, In Japan, T-AVR is officially allowed to indicate the Aortic valve disease. 2. Then Japanese cardiac surgeon should consider and change the 1 st Surgical Aortic Valve Treatment. 3. Average of age for the human being are longer and longer, Also in Japan. 4. We should decide the 1 st treatment of the single aortic valve disease, cindering about the second Aortic valve treatment.
24 T - A V R
25 Full sternotomy,,,,,, Difficult to do the Fast Track treatment,,,,,,? How should we do?
26 Which is better for the 1 st AVR Median Full sternotomy Minimally invasive approach VS.
27 Post operative 4 week Mics-AVR
28 Epic (Abbott) Valve in Valve T-AVR Core Valve (Medtronic) Valve in valve + Considering Indication for the 1 st Surgical Aortic Valve Treatment AT the TAVI Generation
29 Valve in Valve T-AVR Sapien (Edwards) Core Valve (Medtronic) Epic Solo Smart 26 26/29
30 Implantation Technique Intra Annuals suturing technique is required
31 Supra Annuals suturing technique As Valve in Valve Be aware of possibility of coronary obstruction
32 MICS-AVR Implanted Stent Less Aortic Prosthesis Valve Intra Annuals suturing technique 79y/o male, POD8
33 1 st Surgical Aortic Valve Treatment AT the TAVI Generation Less 40y/o Aortic Valve sparing AGE Above 40y/o Bio Prosthesis valve or Solo-Smart Epic or Magna Ease Mechanical VALVE Re-AVR T-AVR
34 MICS-AVR (Solo-Smart ) 2016 Oct. ~ 2018 Sep. Male : Female = 10 : 6 Average of age : 52y/o ( 41~ 85) Average of X-Clamp : ±69 min Average of Operation time : ± 89 min Average of ICU stay : 2 ± 3.1 day Average of hospital stay : 13± 9.1 day No blood transfusion
35 Pre Ope Diagnosis COPD 12 LOS ( EF < 35% ) 1 ASO (ABI<0.6) 1 Kidney dysfunction(cr>1.5 or CCr<40) 3 Carotid disease (> 50% stenosis) 2 Severe DM 3 Old infarction 5 PCI before AVR 4
36 Implanted Valve size 21mm(23) 2 23mm(26) 4 25mm(29) 8 27mm(31) 2
37 Postoperative AR 0 6 Trivial 8 I 2 Ⅱ~Ⅳ 0
38 1. Arrowing us X-clamp the aorta, CONCLUSIONS S-AVR should be the first choice for the aortic valve disease 2. MICS-AVR should consider the 1 st single AVR, Because of patients have a big possibility of the second AVR including T-AVR 3. For the younger patient or good activity patients, If we cannot use the original aortic valve, AVR with stent less prosthesis valve is one of good option. Because of good aortic valve performance after AVR. Then they have a chance to be performed T-AVR with large valve size in their future.
39 Thank You Our hospital Osaka city, Osaka Prefecture, JAPAN
40 University Medical Center Ljubljana ( SLOVENIA) Cardiovascular Surgery (2000~2004, 2011~2012) with Prof. Gersak BORUT
41 Ljubljana SLOVENIA Ljubljana
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