Impact of new technologies and experience on procedural aspects of surgical aortic valve replacement - a process analysis
| Autor: | Eva Roost, Lars Englberger, Fabian Gisler, Christoph Huber, Thierry Carrel, David Reineke, Henriette Most, Bettina Langhammer, Bernhard Winkler, Florian Schönhoff, Maria Nucera |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Aortic valve medicine.medical_specialty medicine.medical_treatment Operative Time 610 Medicine & health Prosthesis Aortic valve replacement Suture (anatomy) Interquartile range medicine.artery medicine Risk of mortality Humans Aged Heart Valve Prosthesis Implantation Aorta ddc:617 business.industry Process Assessment Health Care Suture Techniques Aortic Valve Stenosis General Medicine medicine.disease Surgery Logistic Models medicine.anatomical_structure Aortic Valve Heart Valve Prosthesis Aortic valve stenosis cardiovascular system Female Clinical Competence business |
| Zdroj: | Langhammer, Bettina; Nucera, Maria; Englberger, Lars; Roost, Eva; Reineke, David Christian; Schönhoff, Florian; Most, Henriette; Winkler, Bernhard; Gisler, Fabian; Carrel, Thierry; Huber, Christoph (2017). Impact of new technologies and experience on procedural aspects of surgical aortic valve replacement-a process analysis. Swiss medical weekly, 147(w14464), w14464. EMH Schweizerischer Ärzteverlag 10.4414/smw.2017.14464 Swiss Medical Weekly, Vol. 147 (2017) P. w14464 |
| ISSN: | 1424-7860 |
| Popis: | BACKGROUND Surgical aortic valve replacement (SAVR) is the treatment of choice in severe symptomatic aortic valve disease. New techniques and prostheses have been recently developed to facilitate the procedure and reduce aortic cross-clamp time (AOx). The aim of this study was to analyse the different procedural steps in order to identify the most time-consuming part during aortic clamping time and to compare impact of experience on procedural aspects. METHODS AOx during SAVR was divided into five consecutive steps. Duration of each step was measured. The first procedural step started with clamping of the aorta and ended with the beginning of the second step starting with the resection of the native aortic valve. The third step started with placement of the first valve anchoring suture, the fourth step started with tying of the first suture and the fifth and final step started after the cut of the last suture and ended with removal of the aortic clamp. Surgeons were divided into two groups based on their experience, which in our analysis was defined as a total SAVR experience of more than 100 procedures. RESULTS From March 2013 to August 2015 57 nonconsecutive patients (33% female; age, median 71.0 years, interquartile range 65.0-76.0) undergoing isolated SAVR for severe aortic valve stenosis in our institution were included in this process analysis. Two different prostheses were implanted. Forty-eight (84%) patients received a tissue valve (Perimount Magna Ease, Edwards Lifesciences, Irvine, USA) and 9 (16%) patients received a mechanical prosthesis (Medtronic AP 360, St-Paul, MN, USA). The mean estimated risk of mortality was 1.1% (0.7-1.6) according to the logistic EUROScore II. Overall duration of AOx was 50.5 ± 13.8 min, with 32.3% (16.4 ± 5.9 min) accounting for placing the sutures into the native annulus and the prosthetic sewing ring and 18.5% (9.2 ± 3.0min) accounting for tying and cutting the sutures. Surgeons with more experience performed 35 operations (61.4%) and needed an average of 44.1 ± 11.5 min versus 60.6 ± 11.0 min (p |
| Databáze: | OpenAIRE |
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