The Worshipful Company of Barbers. Mr. John Hunter. History of cardiac surgery. PDA ligation. Blalock-Taussig Shunt

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1 The Worshipful Company of Barbers Puneet Dhawan M.D Assistant Health Sciences Clinical Professor David Geffen School of Medicine at UCLA Assistant Chief Division of Cardiothoracic Surgery Harbor-UCLA Medical Center Cardiothoracic Surgeon, St Jude Medical Center 03/03/ Mr. John Hunter History of cardiac surgery Heart wound 1893,stab wound to the heart repaired by Dr. Daniel Williams WW II army surgeon Harken remove 134 missile from the mediastinum Frederick Trendelenburg performed the first pulmonary embolectomy 3 4 PDA ligation Blalock-Taussig Shunt BP tracing after PDA ligation Published in JAMA 1939 by Gross and Hubert First reported in

2 Cross-circulation Lillehei reported in 1955 Clinical version of Heart lung machine

3 Artificial Heart

4 Aortic Stenosis What are the other symptoms of Aortic Stenosis? Gross specimen of minimally diseased aortic valve (left) and severely stenotic aortic valve (right)

5 Prevalence of Aortic Stenosis What Causes Aortic Stenosis in Adults Aortic stenosis is estimated to be prevalent in up to 7% of the population over the age of Million People in US Over the Age of 65 Percentage Diagnosed with Aortic Stenosis More Common Age-Related Calcific Aortic Stenosis Infection Aortic stenosis in patients over the age of 65 is usually caused by calcific (calcium) deposits associated with aging Aortic stenosis can be caused by various infections It is more likely to affect men than women; 80% of adults with symptomatic aortic stenosis are male Rheumatic Fever Adults who have had rheumatic fever may also be at risk for aortic stenosis Congenital Abnormality In some cases adults may develop aortic stenosis resulting from a congenital abnormality Less Common Major Risk Factors Symptoms of Aortic Stenosis Independent clinical factors associated with degenerative aortic valve disease include the following: Increasing age Male gender Hypertension Smoking Elevated cholesterol What are the symptoms of aortic stenosis? Angina - A sensation of aching, burning, discomfort, fullness, pain, or squeezing in the chest. It may also be felt in the arms, back, jaw, neck, shoulders and throat Fainting - A sudden and brief loss of consciousness Shortness of breath - Feeling winded and tired when walking or lying down Dizziness Rapid or irregular heartbeat Palpitations An uncomfortable awareness of the heart beating rapidly or irregularly Preliminary Diagnosis of Aortic Stenosis Multiple Modalities May Be Used to Diagnose Severe Aortic Stenosis Detection and estimation of disease severity can often be achieved by auscultation Auscultation Transthoracic Echo (TTE) Cardiac Cath. Chest X-ray Electrocardiogram

6 Aortic Stenosis Is Life Threatening and Progresses Rapidly Sobering Perspective Year Survival Survival, % Survival after onset of symptoms is 50% at 2 years Surgical intervention for severe aortic stenosis should be performed promptly once even minor symptoms occur Breast Lung Colorectal Prostate Ovarian Severe Cancer Cancer Cancer Cancer Cancer Inoperable AS* *Using constant hazard ratio. Data on file, Edwards Lifesciences LLC. Analysis courtesy of Murat Tuczu, MD, Cleveland Clinic 5 year survival of breast cancer, lung cancer, prostate cancer, ovarian cancer and severe inoperable aortic stenosis Tissue vs. Mechanical Options for Aortic Valve Replacement High-risk and Inoperable Patients Patients High-risk and Intermediate Risk Patients Transcatheter Aortic Valve Replacement (TAVR) Surgical Aortic Valve Replacement (SAVR) Minimal Incision Valve Surgery (MIVS) Edwards SAPIEN Transcatheter Heart Valve Edwards SAPIEN Transcatheter Heart Valve Transcatheter Aortic Valve Replacement (TAVR) TAVR Procedure Overview The Edwards SAPIEN transcatheter heart valve is indicated for patients with severe symptomatic calcified native aortic valve stenosis who have been examined by a Heart Team including an experienced cardiac surgeon and cardiologist and found to be either inoperable or at high risk for surgical aortic valve replacement. 36 6

7 What is TAVR? Edwards SAPIEN Transcatheter Heart Valve For patients who are either at high risk or too sick for open-heart surgery, TAVR may be an alternative This less invasive procedure allows the aortic valve to be replaced with a new valve while the heart is still beating Bovine pericardial tissue Leaflets matched for thickness and elasticity Stainless steel frame PET skirt Transfemoral Procedural Animation Transapical Procedural Animation Edwards SAPIEN Transcatheter Heart Valve Deployment Characteristics of a TAVR Patient TAVR patients may present with some of the following: Severe, symptomatic native aortic valve stenosis Old age Frailty History of stroke/cva History of syncope Reduced EF Heavily calcified aorta Prior CABG Prior chest radiation History of AFib History of CAD Prior open chest surgery History of COPD Fatigue, slow gait History of renal insufficiency Peripheral vascular disease Diabetes and hypertension

8 MitraClip MitraClip MitraClip MitraClip Atrial Fibrillation

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10 Thoracic Aneurysm

11 61 62 Future of Cardiac Surgery Develop Therapies Extend Human Life Relieve Suffering