Failed Aortic Valve Repairs Lessons Learned
|
|
- Dinah Neal
- 5 years ago
- Views:
Transcription
1 Failed Aortic Valve Repairs Lessons Learned A. Stephane Lambert, MD, FRCPC Munir Boodhwani, MD, MMSc, FRCSC University of Ottawa Heart Institute Ottawa Ontario
2 No Disclosure
3 Why do repairs fail?
4
5 Basic Concepts AI is due to insufficient coaptation Goal of is to increase coaptation Restore/maintain geometry Need enough tissue/good quality tissue
6 How to define inadequate repair? AI and Beyond 1. Residual AI = Insufficient coaptation 2. Quality of coaptation Coaptation length Coaptation Surface Area Level of coaptation - Effective height 3. Geometry Cusp mobility Valve symmetry (tricuspid valve) Gradients (especially bicuspid)
7 186 pts, 18 mo. follow up. 41 pts had 3+ AI Multivariate analysis J Am Coll Cardiol Img 2009;2:931-9
8 le Polain de Waroux, J Am Coll Cardiol Img 2009;2:931-9
9 le Polain de Waroux, J Am Coll Cardiol Img 2009;2:931-9
10 Algorithm le Polain de Waroux, J Am Coll Cardiol Img 2009;2:931-9
11 Effective Height eh as an surrogate for cusp geometry Distance between tip of cusps and plane of VAJ Normal 9.5 mm Schäfers et al, J Thor Cardiovasc Surg, Aug 2006
12 eh correlates with outcome 651 post AV repair Mean follow up 50 month Severity of AI None Mild Moderate Severe eh 9.8 ± 0.9 mm 9.4 ± 1.1 mm 7.9 ± 1.4 mm 6.0 ± 1.0 mm Bierbach et al. Euro J Cardio Thor Surg 2010
13 eh correlates with outcome eh < 9 mm n = 154 eh 9 mm n = 497 None 25 (16%) 309 (62%) Mild 85 (55%) 186 (37%) Moderate 41 (27%) 2 (004%) Severe 3 (0.02%) 0 (0%) Bierbach et al. Euro J Cardio Thor Surg 2010
14
15 Example 1 65 y.o male (76kg) CAD with CABG 2003 (all grafts patent) Recent dyspnea: NYHA class II TTE: Severe (4+) AI; 6 cm aortic root aneurysm; LVEF normal
16 Pre Tricuspid AoV Severely dilated Aortic Root Equilateral Triangle Severe AI Central Origin
17 Pre RCC slightly prolapsed Post cusp restricted (LCC vs NCC?) Severe Root Dilatation Severe AI Eccentric Jet Posteriorly Directed
18 Pre 3D En face view with tilted view Cusps are taut c/w severe root dilatation
19 Pre RCC prolapse worse vs. NCC NCC mobility not bad LCC mobility decreased
20 Pre VAJ 2.3 cm SoV cm STJ 5.4 cm Asc Ao cm (asymmetric?)
21 Analysis Structure Tricuspid Valve RCC prolapse with LCC Restriction Severe root dilatation (asymmetric?) Function Type 1B? Type 3 Is the restriction structural or functional?
22 Repair
23 Post #1
24 What does the surgeon need to know? How much AI (loading conditions) Jet origin (central vs commissural) Jet direction (central vs. eccentric) Cusp motion? Root geometry? Specific coaptation lines? WHAT IS THE MECHANISM? WHERE IS THE PROBLEM?
25 Post #1 Mild to moderate AI Eccentric jet now directed ANTERIORLY
26 Post #1 Root symmetrical Originating from LCC/RCC coaptation line
27 Post #1? Sagging of the LCC
28 Post #1 N L Jet begins at RCC-LCC coaptation and extends anteriorly towards the NCC-RCC commissure
29 Post #1
30 Analysis Mild to moderate (2+) AI Originating from RCC-LCC coaptation Eccentric jet Probable mechanism: relative LCC prolapse
31 Return to Bypass Free margin plication
32 Post #2 Still tiny leak at LCC RCC commissure
33 Post #2 Mild residual AI Same origin, but jet is now CENTRAL
34 Post #2 Coaptation length: 6 mm Effective Height: 9.5 mm VAJ diameter 21 mm
35 Post #2
36 Analysis Level of coaptation well above VAJ Trace AI central Coaptation length > 4mm (6 mm) Effective height > 9mm (9.5 mm) VAJ diameter 21 mm No significant gradient
37 Lessons Learned Preoperative indicators of what cusp repair will be required Impact of changes in aortic root geometry on cusp function Assessment of cusp anatomy following valve sparing surgery
38 Case 2 85 y.o. male, Fairly active, no significant co-morbidities Severe (4+) AI Progressive LV dilatation, LVEDD 70 mm; good LV systolic function.
39 Pre Thickened cusps RCC prolapse? Restricted posterior cusp Posteriorly directed jet
40 Pre Tricuspid valve Central origin of jet
41 Pre VAJ SoV STJ Asc Ao cm 3.7 cm 3.9 cm 3.6 cm
42 Analysis Tricuspid valve Thickened, somewhat restricted cusps Mild dilatation of STJ (Type 1A) Relatively normal VAJ RCC prolapse (Type 2) Thickened cusps (?Type 3)
43 Repair
44 Post #1 Subcommissural Annuloplasty Free margin plication RCC Residual central jet
45 Post #1 Free margin plication on RCC Eccentric 4+ AI 2+ central AI Residual central coaptation defect
46 Analysis Residual AI Short length of coaptation Low effective height Elderly patient who would do very well with prosthesis
47 Final outcome: bioprosthesis
48 Lessons learned Poor tissue quality (Type 3) Low threshold for replacement in 85 y.o.
49 Example 3 35 y.o. active healthy male Presented 5 years ago with BAV & root aneurysm
50 Pre Type 0 BAV Posterior cusp larger than anterior cusp Mild calcification at lateral commissure Trivial AI arising from commissures
51 Pre Thin mobile cusps Aortic Root Aneurysm Minimal AI
52 Pre VAJ SoV STJ Asc Ao cm 6.2 cm 5.9 cm 3.2 cm
53 Analysis Type 0 bicuspid Asymmetric cusps, slight calcification Thin mobile cusps VAJ upper limit normal, SoV & STJ severely dilated (Type 1B)
54 Post #1 Valve sparing root replacement No AI Annulus 26 mm Return to CPB Severe billowing Good coaptation length (6 mm) Low Effective Height (3 mm)
55 Post #2 Free margin resuspension Still mild billowing Good coaptation length / effective height No AI
56 Level of coaptation (effective height) much higher above VAJ after free margin resuspension
57 Delayed Failure Patient presents 5 years later Severe AI Still healthy and active
58 Redo Pre Severe eccentric AI
59 Redo - Pre Thickened cusp edges (resuspension) Dilated VAJ (30 mm) Rest unchanged
60 Surgical findings
61 Final outcome: mechanical prosthesis
62 Analysis - Discussion Complex BAV repair Delayed VAJ dilatation Subcommissural Annuloplasty vs. Valve Sparing Root Replacement
63 SCA vs VAJ Navarra et al. European Journal of Cardio-Thoracic Surgery 2013
64 Thank you!
Aortic Valve Repair: The Brussels Approach Laurent de Kerchove, MD, PhD Cliniques Universitaires St-Luc, IREC, UCL, Brussels, Belgium
Reconstruction of the Aortic Valve and Root: A Practical Approach September 14 th -16 th, Homburg/Saar, Germany Aortic Valve Repair: The Brussels Approach Laurent de Kerchove, MD, PhD Cliniques Universitaires
More informationRepair for Aortic Regurgitation: is it durable?
Repair for Aortic Regurgitation: is it durable? Gébrine El Khoury Cliniques Universitaires St-Luc, IREC, UCL, Brussels, Belgium AATS 95 th Annual Meeting 25-29 April, Seattle Aorrtic valve repair the basics
More informationTransoesophageal echocardiography and decision making in valve surgery
Transoesophageal echocardiography and decision making in valve surgery Intraoperative evaluation of the surgical results in aortic valve / root surgery Catherine Szymanski Disclosures None Sino-tubular
More informationIndications and Late Results of Aortic Valve Repair
Indications and Late Results of Aortic Valve Repair Prof. Gebrine El Khoury Department of Cardiovascular and Thoracic Surgery Cliniques St. Luc Brussels, Belgium Aortic Valve Repair Question # 1 Can the
More informationAortic valve repair: When and how to employ this novel approach?
Aortic valve repair: When and how to employ this novel approach? Konstadinos A Plestis, MD System Chief of Cardiac Thoracic and Vascular Surgery Main Line Health Care System Professor Sidney Kimmel Medical
More informationResults of Aortic Valve Preservation and Repair
Results of Aortic Valve Preservation and Repair Department of Cardiothoracic and Vascular Surgery Cliniques Universitaires St. Luc Brussels, Belgium Gebrine Elkhoury Institutional experience in AV preservation
More informationJoseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of
Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of Pennsylvania, USA AVRS Philadelphia Sept 2016 Pictures courtesy
More informationAnnular Stabilization Techniques in the Context of Aortic Valve Repair
Annular Stabilization Techniques in the Context of Aortic Valve Repair Prashanth Vallabhajosyula, MD MS University of Pennsylvania, Philadelphia, Pennsylvania 2 nd North American Aortic Valve Repair Symposium
More informationLessons From The Computer Model and How We Do Root Replacement
Lessons From The Computer Model and How We Do Root Replacement Ehud Raanani, MD Cardiac Surgery Leviev Cardiothoracic and Vascular Center Sheba Medical Center Sackler School of Medicine, Tel Aviv University
More informationAortic Valve Repair: State of the art
EuroValve, March 10-11 2016, Brussels Aortic Valve Repair: State of the art Laurent de Kerchove, MD, PhD Cliniques Universitaires St-Luc, IREC, UCL, Brussels AV repair: the origine of annuloplasty Circumclusion
More informationAortic Valve Repair a Modular and Geometric Approach. H.-J. Schäfers Dept. of Thoracic and Cardiovascular Surgery University Hospital of Saarland
Aortic Valve Repair a Modular and Geometric Approach H.-J. Schäfers Dept. of Thoracic and Cardiovascular Surgery University Hospital of Saarland 12.09.2018 Limitations: Purely echocardiographic, does not
More informationAortic valve repair: Techniques and Pitfalls. Allan Stewart, MD Columbia University Medical Center New York, NY
Aortic valve repair: Techniques and Pitfalls Allan Stewart, MD Columbia University Medical Center New York, NY Take Away Points 1. Valve anatomy is essential to assess repair 2. Unique Decisions with Aneurysm/AI
More informationJoseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of
Joseph E. Bavaria, M.D. Roberts Measy Professor and Vice Chief CardioVascular Surgery Director: Thoracic Aortic Surgery Program University of Pennsylvania, USA North American Valve Repair, Philadelphia
More informationReimplantation Should Be Preferred
Reconstruction of the Aortic Valve and Root: A Practical Approach September 13 th -15 th, 2017, Homburg/Saar, Germany Reimplantation Should Be Preferred Laurent de Kerchove, MD, PhD Cliniques Universitaires
More informationThe Bicuspid AV Surgical Conisiderations
The Bicuspid AV Surgical Conisiderations Ehud Raanani, MD Cardiothoracic Surgery, Sheba Medical Center Sackler School of Medicine, Tel Aviv University MAY 15, 2014 Homburg BAV Repair Congenital variations
More informationThe Bicuspid AV Surgical Considerations
The Bicuspid AV Surgical Considerations Ehud Raanani, MD Cardiothoracic Surgery, Sheba Medical Center Sackler School of Medicine, Tel Aviv University September 12, 2014 Homburg BAV Repair Congenital variations
More informationReconstruction of the Aortic Valve and Root A Practical approach Failures after aortic valve repair. Diana Aicher. September 16 th -18 th 2015
Reconstruction of the Aortic Valve and Root A Practical approach Failures after aortic valve repair Diana Aicher September 16 th -18 th 2015 Classification of failures- root repair 51/810 acute/ intraoperative
More informationFunctional anatomy of the aortic root. ΔΡΟΣΟΣ ΓΕΩΡΓΙΟΣ Διεσθσνηής Καρδιοθωρακοτειροσργικής Κλινικής Γ.Ν. «Γ. Παπανικολάοσ» Θεζζαλονίκη
Functional anatomy of the aortic root ΔΡΟΣΟΣ ΓΕΩΡΓΙΟΣ Διεσθσνηής Καρδιοθωρακοτειροσργικής Κλινικής Γ.Ν. «Γ. Παπανικολάοσ» Θεζζαλονίκη What is the aortic root? represents the outflow tract from the LV provides
More informationWhen Does 3D Echo Make A Difference?
When Does 3D Echo Make A Difference? Wendy Tsang, MD, SM Assistant Professor, University of Toronto Toronto General Hospital, University Health Network 1 Practical Applications of 3D Echocardiography Recommended
More information2 nd AVRS 2016: Nimesh D. Desai, M.D., Ph.D. Co Director, Aortic and Vascular Center for Excellence University of Pennsylvania
2 nd AVRS 2016: Nimesh D. Desai, M.D., Ph.D. Co Director, Aortic and Vascular Center for Excellence University of Pennsylvania Knowing what to Do Know what NOT to Do The Exquisite art of Timing. or is
More informationExpanding Relevance of Aortic Valve Repair Is Earlier Operation Indicated?
Expanding Relevance of Aortic Valve Repair Is Earlier Operation Indicated? RM Suri, V Sharma, JA Dearani, HM Burkhart, RC Daly, LD Joyce, HV Schaff Division of Cardiovascular Surgery, Mayo Clinic, Rochester,
More informationAortic valve insufficiency in aortic root aneurysms: consider every valve for repair
Review Article on Cardiac Surgery Page 1 of 7 Aortic valve insufficiency in aortic root aneurysms: consider every valve for repair Talal Al-Atassi, Munir Boodhwani Division of Cardiac Surgery, University
More informationEffects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve Sparing Surgery
Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve Sparing Surgery Laurent de Kerchove, MD; Munir Boodhwani, MD, MMSC; David Glineur, MD; Alain Poncelet, MD; Robert Verhelst, MD;
More informationEchocardiographic Evaluation of Primary Mitral Regurgitation
Echocardiographic Evaluation of Primary Mitral Regurgitation Roberto M Lang, MD 0-10 o ME 4CH Med A2 P2 50-70 o Commissural P3 P1 A2 80-100 o ME 2CH P3 A2 A1 A1 125-135 o - ME Long axis P2 A2 P3 A3 P2
More informationValve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair
Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair Laurent de Kerchove, MD, a Munir Boodhwani, MD, MMSC, d David Glineur, MD, a
More informationOutcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease TIRONE E. DAVID, MD ; SEMIN THORAC CARDIOVASC SURG 19:116-120c 2007 ELSEVIER INC. PRESENTED BY INTERN 許士盟 Mitral valve
More informationPart II: Fundamentals of 3D Echocardiography: Acquisition and Application
Part II: Fundamentals of 3D Echocardiography: Acquisition and Application Dr. Bruce Bollen 3D matrix array TEE probes provide options for both 2D and 3D imaging. Indeed, their utility in obtaining multiple
More informationLate secondary TR after left sided heart disease correction: is it predictibale and preventable
Late secondary TR after left sided heart disease correction: is it predictibale and preventable Gilles D. Dreyfus Professor of Cardiothoracic surgery Nath J, et al. JACC 2004 PREDICT Incidence of secondary
More informationAortic Valve Repair - Alternative to Replacement
Aortic Valve Repair - Alternative to Replacement Seite 1 Dept. of Thoracic and Cardiovascular Surgery University Hospital of Saarland Homburg/ Saar Germany Seite 2 Aortic Valve - Historic Repair Attempts
More informationNew Technique for Aortic Valve Functional Annulus Reshaping Using a Handmade Prosthetic Ring
New Technique for Aortic Valve Functional Annulus Reshaping Using a Handmade Prosthetic Ring Khalil Fattouch, MD, PhD, Roberta Sampognaro, MD, Giuseppe Speziale, MD, and Giovanni Ruvolo, MD Department
More information3D- and Multidimensional Echocardiography in Aortic Valve Repair
Reconstruction of the Aortic Valve and Root - A Practical Approach - 3D- and Multidimensional Echocardiography Thursday 15 th September - 14.00 Practice must always be founded on sound theory. Leonardo
More informationImaging to select patients for Transcatheter TV
Imaging to select patients for Transcatheter TV Jeroen J Bax Dept of Cardiology Leiden Univ Medical Center The Netherlands San Diego, february 2018 Research grants: Medtronic, Biotronik, Boston Scientific,
More informationBicuspid aortic root spared during ascending aorta surgery: an update of long-term results
Short Communication Bicuspid aortic root spared during ascending aorta surgery: an update of long-term results Marco Russo, Guglielmo Saitto, Paolo Nardi, Fabio Bertoldo, Carlo Bassano, Antonio Scafuri,
More informationPresenter Disclosure. Patrick O. Myers, M.D. No Relationships to Disclose
Presenter Disclosure Patrick O. Myers, M.D. No Relationships to Disclose Aortic Valve Repair by Cusp Extension for Rheumatic Aortic Insufficiency in Children Long term Results and Impact of Extension Material
More informationMechanisms of Recurrent Aortic Regurgitation After Aortic Valve Repair
JACC: CARDIOVASCULAR IMAGING VOL. 2, NO. 8, 2009 2009 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-878X/09/$36.00 PUBLISHED BY ELSEVIER INC. DOI:10.1016/j.jcmg.2009.04.013 Mechanisms of Recurrent
More informationImaging in TAVI. Jeroen J Bax Dept of Cardiology Leiden Univ Medical Center The Netherlands Davos, feb 2013
Imaging in TAVI Jeroen J Bax Dept of Cardiology Leiden Univ Medical Center The Netherlands Davos, feb 2013 Research grants: Medtronic, Biotronik, Boston Scientific, St Jude, BMS imaging, GE Healthcare,
More informationEdward P. Chen MD. Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta, Georgia
David Procedure in Acute Type A Dissection Edward P. Chen MD Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta, Georgia The Houston Aortic
More informationΧειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας
Χειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας Dr Χρήστος ΑΛΕΞΙΟΥ MD, PhD, FRCS(Glasgow), FRCS(CTh), CCST(UK) Consultant Cardiothoracic Surgeon Normal Mitral Valve Function Mitral Regurgitation
More informationHow to Perform a Valve Sparing Root Replacement Joseph S. Coselli, M.D.
How to Perform a Valve Sparing Root Replacement Joseph S. Coselli, M.D. AATS International Cardiovascular Symposium 2017 Session 6: Technical Aspects of Open Surgery on the Aortic Valve Sao Paulo, Brazil
More informationI have financial relationships to disclose Honoraria from: Edwards
I have financial relationships to disclose Honoraria from: Edwards Mitral Valve Annuloplasty in Ischemic Mitral regurgitation Jean François Avierinos Hôpital Timone Marseille August 28, 2012 Ischemic MR
More informationAortic Root Surgery: ECHO Analysis Repair versus Replacement
UNIVERSITY OF ZAGREB SCHOOL OF MEDICINE Polona Koritnik Aortic Root Surgery: ECHO Analysis Repair versus Replacement GRADUATE THESIS Zagreb 2016 UNIVERSITY OF ZAGREB SCHOOL OF MEDICINE Polona Koritnik
More informationReconstruction of the Aortic Valve and Root A Practical approach Why and when to repair the aortic valve. Diana Aicher. September 16 th - 18 th 2015
Reconstruction of the Aortic Valve and Root A Practical approach Why and when to repair the aortic valve Diana Aicher September 16 th - 18 th 2015 Why repair the aortic valve? Aortic Valve Replacement
More informationDespite advances in our understanding of the pathophysiology
Suture Relocation of the Posterior Papillary Muscle in Ischemic Mitral Regurgitation Benjamin B. Peeler MD,* and Irving L. Kron MD,*, *Department of Cardiovascular Surgery, University of Virginia, Charlottesville,
More informationAnatomy of aortic valve and root Emmanuel Lansac MD PhD
Anatomy of aortic valve and root Emmanuel Lansac MD PhD Cardiac Surgery Institut Mutualiste Montsouris, Paris, France The aortic valve : a passive or dynamic structure? Leonardo da Vinci 1508 Quadr Anat
More informationAnatomy of aortic valve and root
Anatomy of aortic valve and root Emmanuel Lansac, Isabelle Di Centa Cardiac Surgery Institut Mutualiste Montsouris, Paris, France The aortic valve : a passive or dynamic structure? Leonardo da Vinci 1508
More informationAtrioventricular valve repair: The limits of operability
Atrioventricular valve repair: The limits of operability Francis Fynn-Thompson, MD Co-Director, Center for Airway Disorders Surgical Director, Pediatric Mechanical Support Program Surgical Director, Heart
More informationLate results of aortic root repair & replacement. John Pepper Imperial College and Royal Brompton Hospital, London, UK.
Late results of aortic root repair & replacement John Pepper Imperial College and Royal Brompton Hospital, London, UK. REPLACEMENT OF ASCENDING AORTA AND ROOT Interposition graft Valve sparing VR + graft
More informationRepair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes
ACQUIRED CARDIOVASCULAR DISEASE Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes Munir Boodhwani, MD, MMSc, Laurent de Kerchove, MD, David Glineur,
More informationThe Ross Procedure: Outcomes at 20 Years
The Ross Procedure: Outcomes at 20 Years Tirone David Carolyn David Anna Woo Cedric Manlhiot University of Toronto Conflict of Interest None The Ross Procedure 1990 to 2004 212 patients: 66% 34% Mean age:
More informationICE: Echo Core Lab-CRF
APPENDIX 1 ICE: Echo Core Lab-CRF Study #: - Pt Initials: 1. Date of study: / / D D M M M Y Y Y Y 2. Type of Study: TTE TEE 3. Quality of Study: Poor Moderate Excellent Ejection Fraction 4. Ejection Fraction
More informationMitral valve treatment in advanced heart failure: Repair, Replacement, MitraClip. Nicola Buzzatti, MD San Raffaele Scientific Institute Milan, Italy
Mitral valve treatment in advanced heart failure: Repair, Replacement, MitraClip Nicola Buzzatti, MD San Raffaele Scientific Institute Milan, Italy Disclosures I have nothing to disclose FMR: a ventricular
More informationSparing aortic valve techniques
Surgical Technique Sparing aortic valve techniques Rubén Álvarez-Cabo Cardiac Surgery Department, Heart Area, Central University Hospital of Asturias (HUCA), Oviedo, Spain Correspondence to: Rubén Álvarez-Cabo.
More informationAortic Regurgitation & Aorta Evaluation
VALVULAR HEART DISEASE Regurgitation Valvular Lessions 2017 Aortic Regurgitation & Aorta Evaluation Jorge Eduardo Cossío-Aranda MD, FACC Chairman of Outpatient Care Department Instituto Nacional de Cardiología
More informationCandice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada
PVR Following Repair of TOF Now? When? Candice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada Late Complications after TOF repair Repair will be necessary
More informationReally Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients?
Really Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients? David H. Adams, MD Cardiac Surgeon-in-Chief Mount Sinai Health System Marie Josée and Henry R. Kravis Professor and
More informationJoseph E. Bavaria, MD
EACTS Master Class on Aortic Valve Repair Joseph E. Bavaria, MD Director, Thoracic Aortic Surgery Program Roberts Measey Professor and Vice Chair of CV Surgery University of Pennsylvania Immediate-Past
More informationHani K. Najm MD, Msc, FRCSC FACC, FESC President Saudi Society for Cardiac Surgeons Associate Professor of Cardiothoracic Surgery King Abdulaziz
Hani K. Najm MD, Msc, FRCSC FACC, FESC President Saudi Society for Cardiac Surgeons Associate Professor of Cardiothoracic Surgery King Abdulaziz Cardiac Centre Riyadh, Saudi Arabia Decision process for
More informationReconstructive surgery of the aortic root
Reconstructive surgery of the aortic root Reconstructive surgery of the aortic root Academician d-r Zan Mitrev MDFETCS Special hospital for surgery Fillip II Skopje - Macedonia february, 2011 Reconstructive
More informationUnusual Causes of Aortic Regurgitation. Case 1
Unusual Causes of Aortic Regurgitation Judy Hung, MD Cardiology Division Massachusetts General Hospital Boston, MA No Disclosures Case 1 54 year old female with h/o cerebral aneurysm and vascular malformation
More informationConflict of Interests
Introduction to Interventional Echocardiography Roberto M Lang, MD Tomtec Conflict of Interests Research Grants Philips Medical Imaging Research Grants Speakers bureau Advisory bureau 1 Structural Heart
More informationPosterior leaflet prolapse is the most common lesion seen
Techniques for Repairing Posterior Leaflet Prolapse of the Mitral Valve Robin Varghese, MD, MS, and David H. Adams, MD Posterior leaflet prolapse is the most common lesion seen in degenerative mitral valve
More informationSeverity of AS Degree of AV calcification (? Bicuspid AV), annulus size, & aortic root
The role of Cardiac Imaging modalities in evaluation & selection of patients for Trans-catheter Aortic Valve Implantation Dr.Saeed AL Ahmari Consultant Cardiologist Prince Sultan Cardaic Center, Riyadh
More informationDisclosures. ESC Munich 2012 Bernard Iung, MD Consultancy: Abbott Boehringer Ingelheim Bayer Servier Valtech
Disclosures ESC Munich 2012 Bernard Iung, MD Consultancy: Abbott Boehringer Ingelheim Bayer Servier Valtech Speaker s fee Edwards Lifesciences Sanofi-Aventis Decision Making in Patients with Multivalvular
More informationCongenital. Unicuspid Bicuspid Quadricuspid
David Letterman s Top 10 Aortic Stenosis The victim can be anyone: Echo is the question and the answer!!!! Hilton Head Island Echocardiography Conference 2012 Timothy E. Paterick, MD, JD, MBA Christopher
More informationBicuspid Aortic Valve: Only Valvular Disease? Artur Evangelista
Bicuspid Aortic Valve: Only Valvular Disease? Artur Evangelista Bicuspid aortic valve BAV is not only a valvulogenesis disorder but also represent coexisting aspects of a genetic disorder of the aorta
More informationWHAT CAN WE LEARN FROM COMPUTER SIMULATION?
WHAT CAN WE LEARN FROM COMPUTER SIMULATION? Ehud Raanani, MD Gil Marom, Phd Cardiothoracic Surgery, Sheba Medical Center Sackler School of Medicine, Biomechanical Engineering, Tel Aviv University Homburg,
More informationAortic root reconstructive surgery - new created technique for aortic stenosis
Aortic root reconstructive surgery - new created technique for aortic stenosis Reconstructive surgery of the aortic root Academician d-r Zan Mitrev, T.Anguseva, E.Stoicovski, E Idoski Special hospital
More informationBasic principles of Rheumatic mitral valve Repair
Basic principles of Rheumatic mitral valve Repair Prof. Gebrine El Khoury, MD DEPARTMENT OF CARDIOVASCULAR AND THORACIC SURGERY ST. LUC HOSPITAL - BRUSSELS, BELGIUM 1 Rheumatic MV disease MV repair confers
More informationSurgical Repair of the Mitral Valve Presenter: Graham McCrystal Cardiothoracic Surgeon Christchurch Public Hospital
Mitral Valve Surgical intervention Graham McCrystal Chairs: Rajesh Nair & Gerard Wilkins Surgical Repair of the Mitral Valve Presenter: Graham McCrystal Cardiothoracic Surgeon Christchurch Public Hospital
More informationSurgical Procedures and Complications
Radiological Society of North America, RSNA 2013 Refresher Course Program: Vascular Track Surgical Procedures and Complications Learning objectives Outline RC 112 : Key Concepts: Surgical Procedures and
More informationThe Edge-to-Edge Technique f For Barlow's Disease
The Edge-to-Edge Technique f For Barlow's Disease Ottavio Alfieri, Michele De Bonis, Elisabetta Lapenna, Francesco Maisano, Lucia Torracca, Giovanni La Canna. Department of Cardiac Surgery, San Raffaele
More informationRegurgitant Lesions. Bicol Hospital, Legazpi City, Philippines July Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA
Regurgitant Lesions Bicol Hospital, Legazpi City, Philippines July 2016 Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA Aortic Insufficiency Valve anatomy and function LVOT and
More informationAortic Regurgitation and Aortic Aneurysm - Epidemiology and Guidelines -
Reconstruction of the Aortic Valve and Root - A Practical Approach - Aortic Regurgitation and Aortic Aneurysm Wednesday 14 th September - 9.45 Practice must always be founded on sound theory. Leonardo
More informationPatrick O. Myers, MD, 1,2 Pedro J. del Nido, MD, 1 Sitaram M. Emani, MD, 1 Gerald R. Marx, MD, 3 Christopher W. Baird, MD 1
Valve-Sparing Aortic Root Replacement and Remodeling with Complex Aortic Valve Reconstruction in Children and Young Adults with Moderate or Severe Aortic Regurgitation Patrick O. Myers, MD, 1,2 Pedro J.
More informationPARAVALVULAR LEAK POST TAVR. Elements of Follow-up Post TAVR
PARAVALVULAR LEAK POST TAVR David S Rubenson MD FACC FASE Founding Director, Cardiac Non-Invasive Laboratory Scripps Clinic Medical Group number 1 Elements of Follow-up Post TAVR JACC CV Imag 2016;9:193
More informationPROSTHETIC VALVE BOARD REVIEW
PROSTHETIC VALVE BOARD REVIEW The correct answer D This two chamber view shows a porcine mitral prosthesis with the typical appearance of the struts although the leaflets are not well seen. The valve
More informationOperate NOT every BAV aorta at 5 cm. Markus Schwerzmann, MD
Operate NOT every BAV aorta at 5 cm Markus Schwerzmann, MD Historical perspective Curr Probl Cardiol 2008;33:203-77 Yale Center for thoracic aortic disease database (2000): 1600 patients with a thoracic
More informationWhat are the best diagnostic tools to quantify aortic regurgitation?
What are the best diagnostic tools to quantify aortic regurgitation? Agnès Pasquet, MD, PhD Pôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université catholique de Louvain
More informationDisclosure Statement of Financial Interest Saibal Kar, MD, FACC
MitraClip Therapy Saibal Kar, MD, FACC, FAHA, FSCAI Director of Interventional Cardiac Research Program Director, Interventional Cardiology Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
More informationState of the art in reconstruction of the ascending aorta with or without valve reconstruction
State of the art in reconstruction of the ascending aorta with or without valve reconstruction PD Dr Diana Aicher Universitätskliniken des Saarlandes Homburg/Germany ESBV Straßbourg, May 10 2013 Background
More information(Ann Thorac Surg 2008;85:845 53)
I Made Adi Parmana The utility of intraoperative TEE has become increasingly more evident as anesthesiologists, cardiologists, and surgeons continue to appreciate its potential application as an invaluable
More informationAortic Valve Resuspension in Ascending Aortic Aneurysm Repair With Aortic Insufficiency
Aortic Valve Resuspension in Ascending Aortic Aneurysm Repair With Aortic Insufficiency Paul Simon, MD, Anton Mortiz, MD, Reinhard Moidl, MD, Natascha Kupilik, MD, Martin Grabenwoeger, MD, Marek Ehrlich,
More informationSurgery For Ebstein Anomaly
Surgery For Ebstein Anomaly Christian Pizarro, MD Chief, Pediatric Cardiothoracic Surgery Director, Nemours Cardiac Center Alfred I. dupont Hospital for Children Professor of Surgery and Pediatrics Sidney
More informationPVL Assessment. Is paravalvular regurgitation after TAVR still an important consideration in 2018?
Joint Meeting 1 Aortic and Mitral Club Chairpersons: S.Adamopoulos, M. Vavuranakis, L. Michalis, P. Nihoyannopoulos PVL Assessment. Is paravalvular regurgitation after TAVR still an important consideration
More informationPrimary Mitral Regurgitation
EURO VALVE Madrid News from Valves Guidelines 2012: What s new and Why? Primary Mitral Regurgitation Luc A. Pierard, MD, PhD Professor of Medicine Head of the Department of Cardiology Heart Valve Clinic,
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationGender Differences in Valvular Heart Disease. Linda D. Gillam, MD FESC Disclosure: Core Lab services Edwards Lifesciences
Gender Differences in Valvular Heart Disease Linda D. Gillam, MD FESC Disclosure: Core Lab services Edwards Lifesciences Obstacles Interest in gender differences is a relatively new phenomenon Registries/RCT
More informationAortic valve repair is an accepted option for aortic valve
Complex Aortic Valve Disease in Children Christopher W. Baird, MD,* and Pedro J. del Nido, MD Aortic valve repair is an accepted option for aortic valve pathologic conditions in children and young adults.
More informationValve Analysis and Pathoanatomy: THE MITRAL VALVE
: THE MITRAL VALVE Marc R. Moon, M.D. John M. Shoenberg Chair in CV Disease Chief, Cardiac Surgery Washington University School of Medicine, St. Louis, MO Secretary, American Association for Thoracic Surgery
More informationThe need for right ventricular outflow tract reconstruction
Polytetrafluoroethylene Bicuspid Pulmonary Valve Implantation James A. Quintessenza, MD The need for right ventricular outflow tract reconstruction and pulmonary valve replacement is increasing for many
More informationManagement of Difficult Aortic Root, Old and New solutions
Management of Difficult Aortic Root, Old and New solutions Hani K. Najm MD, Msc, FRCSC,, FACC, FESC Chairman, Pediatric and Congenital Heart Surgery Cleveland Clinic Conflict of Interest None Difficult
More informationACD. Tirone E. David, MD, Christopher M. Feindel, MD, Susan Armstrong, MSc, and Manjula Maganti, MSc
Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to treat aortic insufficiency in patients with ascending aortic aneurysm Tirone E. David, MD, Christopher M.
More informationIntroduction. Aortic Valve. Outflow Tract and Aortic Valve Annulus
Chapter 1: Surgical anatomy of the aortic and mitral valves Jordan RH Hoffman MD, David A. Fullerton MD, FACC University of Colorado School of Medicine, Department of Surgery, Division of Cardiothoracic
More informationHani K. Najm MD, Msc, FRCSC, FRCS (Glasgow), FACC, FESC President of Saudi Heart Association King Abdulaziz Cardiac Centre Riyadh, Saudi Arabia.
Hani K. Najm MD, Msc, FRCSC, FRCS (Glasgow), FACC, FESC President of Saudi Heart Association King Abdulaziz Cardiac Centre Riyadh, Saudi Arabia. Decision process for Management of any valve Timing Feasibility
More informationDECLARATION OF CONFLICT OF INTEREST. No disclosures
DECLARATION OF CONFLICT OF INTEREST No disclosures Congenital Aortic Valve Disease and Aortopathy: Recent Advances Sub- and Supravalvular Aortic Stenosis Westfälische Wilhelms-Universität Münster Helmut
More informationSurgical Treatment of Aortic Valve Regurgitation Secondary to Ascending Aorta Aneurysm: Is Adjunctive Subcommissural Annuloplasty Necessary?
Surgical Treatment of Aortic Valve Regurgitation Secondary to Ascending Aorta Aneurysm: Is Adjunctive Subcoissural Annuloplasty Necessary? Charles Mve Mvondo, MD, Paolo Nardi, MD, PhD, Carlo Bassano, MD,
More informationAn Intra-Annular Hemispherical Annuloplasty Frame for Aortic Valve Repair J. Scott Rankin
An Intra-Annular Hemispherical Annuloplasty Frame for Aortic Valve Repair J. Scott Rankin Centennial Medical Center, Vanderbilt University, Nashville, TN, USA Background and aim of the study: A Hemispherical
More informationAortic Stenosis: UPDATE Anjan Sinha, MD Krannert Institute of Cardiology
Aortic Stenosis: UPDATE 2010 Anjan Sinha, MD Krannert Institute of Cardiology None Disclosures 67-Year-Old Male Dyspnea and angina Class III heart failure No PND or orthopnea 3/6 late peak SEM Diminished
More informationAortic Stenosis: Interventional Choice for a 70-year old- SAVR, TAVR or BAV? Interventional Choice for a 90-year old- SAVR, TAVR or BAV?
Aortic Stenosis: Interventional Choice for a 70-year old- SAVR, TAVR or BAV? Interventional Choice for a 90-year old- SAVR, TAVR or BAV? Samin K Sharma, MD, FACC, FSCAI Director Clinical & Interventional
More information