Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy
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Minim Invasive Ther Allied Technol · Jan 2009
ReviewSutureless aortic valves over the last 45 years.
Degenerative and calcified aortic stenosis is the most common form of adult valvular heart disease, and surgical aortic valve replacement (AVR) with the use of extracorporeal circulation (ECC) is currently the method of choice which can be performed at low risk. However, older patients with multiple pre-existing 'high-risk' comorbid conditions may benefit from reduced ECC time and thus reduced myocardial ischemia by the use of minimally invasive or interventional aortic valve implantation. Therefore, a sutureless concept of aortic valve implantation came up in the early sixties. ⋯ To date, there is a growing need for fast sutureless implantation of valve prostheses due to an increase in comorbidities. New challenging fields in aortic valve surgery have been recently rediscovered followed by an improvement of the sutureless valve implantation technique. Therefore, we reviewed the current and historical literature describing valve design and materials, as well as clinical data based on valve-related complications or morbidity/mortality.
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Minim Invasive Ther Allied Technol · Jan 2009
Guidance of percutaneous transcatheter aortic valve implantation by real-time three-dimensional transesophageal echocardiography--A single-center experience.
Percutaneous transcatheter aortic valve implantation (TAVI) is an evolving interventional therapy for high-risk, non-surgical patients with severe, symptomatic aortic valve stenosis (AS). As a standard procedure, 2D transesophageal echocardiography has been used for the preinterventional assessment of the native valve and measurement of the aortic annulus as well as for intraprocedural guidance. Recently, a new matrix array, transesophageal probe for real-time three-dimensional echocardiography (RT3D-TEE) has been introduced. ⋯ This new technology should also enable accurate guiding of percutaneous cardiac interventions by providing immediate information on prosthesis position and function in real-time. In our preliminary clinical experience real-time three-dimensional transesophageal echocardiography (RT3D TEE) was demonstrated to provide improved guiding of percutaneous aortic valve replacement by superior spatial visualisation of the cardiac structures and facilitated the detection of procedure-related complications. Due to the advantages of real-time 3D TEE monitoring, this technique might improve the outcome of patients treated with percutaneous aortic valve replacement.
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Minim Invasive Ther Allied Technol · Jan 2009
New techniques for the treatment of valvular aortic stenosis--transcatheter aortic valve implantation with the SAPIEN heart valve.
Acquired aortic stenosis (AS) resulting from calcification of the aortic valve is the most frequent acquired valve disease in Europe. Due to the increasing average life expectancy the population in the western industrial world is aging, and consequently the prevalence of AS requiring aortic valve replacement (AVR), particularly in older patients, is continuously increasing. However, the risk of conventional AVR with the use of sternotomy, cardiopulmonary bypass, and cardioplegic cardiac arrest is obviously higher in the elderly patient, in whom significant comorbidities may additionally pre-exist. ⋯ Thus, there seems to be a role for less invasive treatment options, like transcatheter aortic valve implantation (TAVI) techniques, addressing an unmet patient and medical need. Today, an increasing number of different transcatheter heart valve devices for aortic valve implantation is coming up; however, so far only for two systems there is broad clinical experience with human implantations. The following article is aimed to describe the current transcatheter aortic valve implantation technique with full details of the procedural steps, both via the transfemoral and via the transapical access using the balloon-expandable SAPIEN transcatheter aortic heart valve device.
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Minim Invasive Ther Allied Technol · Jan 2009
MR-compatible polyetheretherketone-based guide wire assisting MR-guided stenting of iliac and supraaortic arteries in swine: feasibility study.
The purpose of this study was to demonstrate first magnetic resonance (MR)-guided stenting of iliac and supraaortic arteries using a polyetheretherketone-based (PEEK) MR-compatible guide wire. In vitro and animal experiments were performed in a short magnet wide-bore scanner (1.5 Tesla, Espree, Siemens Healthcare, Erlangen, Germany). For all experiments, a 0.035'' MR-compatible guide wire prototoype was used. ⋯ Guide wire pushability and endovascular device support were good. The PEEK-based MR-compatible guide wire is well visible and usable under MR-guidance. It supports over-the-wire treatment of iliac arteries and supraaortic arteries.
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Minim Invasive Ther Allied Technol · Jan 2008
Comparative StudyOpen vs. laparoscopic pyloromyotomy--a retrospective analysis.
Laparoscopic pyloromyotomy has obtained increasing importance in the last years. However, there is no proof of an obvious advantage of the laparoscopic over the open approach. This retrospective analysis of 157 infants with pyloromyotomies (129 open and 28 laparoscopic procedures) should settle the benefit of one of these procedures. ⋯ There was no difference in the complication rate as compared to the open procedure. The recovery time was shorter in the laparoscopic group. A superiority of the laparoscopic pyloromyotomy over the open procedure is suggested by the ascertained data.