surgery-ortho-2017-posters-accepted-abstracts

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academies

International Surgery and Ortho Conference

October 25-26, 2017 | Toronto, Canada

Case Rep Surg Invasive Proced 2017 | Volume 1 Issue 3

ranscatheter aortic valve replacement TAVI has become

a frequently used additional option for elderly and high/

intermediate risk patients. The transfemoral approach is

mostly preferred. Alternatively, in case of small femoral

vessels, severe arterial occlusive disease or other vascular

abnormalities, the transapical approach or an access via

the subclavian arteries is considered. The decision is such

determinedbythevascularpathology.However,therearealso

patients with accompanying cardiac or vascular pathologies

not amenable for current TAVI techniques and we were

looking for alternative techniques which are determined by

these patients need. One frequently seen adjunctive disease

is the occlusion or severe stenosis of the carotid arteries and

many of these patients have already suffered from a stroke

or a TIA. So, we developed a combination of typical carotid

endarterectomy, also under local anesthesia, and, during the

same procedure, a transcarotid aortic valve replacement.

To avoid an impairment of blood flow through the newly

reconstructed neck vessel, a vascular prosthesis is connected

side to side to the common carotid artery, facilitating the

introduction of the sheaths and avoiding its positioning

inside the native vessel. Another problem is created by

concomitant heart pathologies additional to the aortic valve

disease. As ischemic time matters, especially in this cohort

of elderly risk patients, we still operate these patients under

extracorporeal circulation and cardioplegic arrest, initially

addressing the concomitant pathologies like severe coronary

artery or mitral/tricuspid valve disease but finally insert

transcatheter valve prosthesis directly via the ascending

aorta. By this hybrid approach, a complete surgical treatment

can be achieved and at the same time a significant reduction

of the cross-clamp time, even compared to new suture less

valves. This is also reflected by lowered mortality among

these patients. We consider these examples a step towards

a minimally invasive and at the same time individualized

surgical therapy not primarily determined by access site or

incision size but by the patient’s pathologies.

TAVI: Alternative approaches and techniques

Rainer Moosdorf

University Hospital Marburg, Germany