Freehand allograft aortic valve replacement and aortic root replacement
| Autor: | Aria DiBiase, D. Craig Miller, Ann F. Bolger, Frederick G. St. Goar, Thomas Bartzokis |
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| Rok vydání: | 1991 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic dissection Aortic valve medicine.medical_specialty Mitral regurgitation business.industry medicine.medical_treatment Hemodynamics medicine.disease law.invention Surgery Transplantation medicine.anatomical_structure Aortic valve replacement Valve replacement law Internal medicine cardiovascular system medicine Cardiopulmonary bypass Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 101:545-554 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/s0022-5223(19)36740-6 |
| Popis: | Seventeen consecutive patients undergoing 20 planned aortic valve replacements with allograft valves at Stanford University Medical Center were studied with intraoperative epicardial echocardiography and Doppler color flow mapping before and after cardiopulmonary bypass. Native aortic valves were replaced in 12 of the 20 patients, and eight patients underwent second aortic valve procedures. In 17 of 20 patients allograft selection was guided by prebypass echocardiographic estimates of annular diameter and/or length of allograft aortic root required. Other prebypass findings included unanticipated severe mitral regurgitation in one patient (which precluded allograft aortic valve replacement), left-to-right shunts in five patients, ascending aortic dissection in one, and aortic root disease necessitating coronary reimplantation or bypass in two. Postbypass echocardiography demonstrated acceptable competency of 18 of 19 allograft valves (mild or no aortic insufficiency). Postbypass echocardiography also documented successful repair of four of five shunts and mild mitral regurgitation in 15 of 19 patients (versus 11 of 19 before bypass). Conclusions: Intraoperative echocardiography-Doppler mapping is a useful adjunct for allograft aortic valve or aortic root replacement; it allows confident selection of appropriate tissue size before aortic crossclamping, which minimizes delay from allograft thawing procedures. It also provides helpful information about the extent of aortic root disease and coronary ostial anatomy before bypass, confirms allograft competency after bypass, and detects accompanying valvular and other hemodynamic lesions before and after allograft valve replacement. |
| Databáze: | OpenAIRE |
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