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AORTIC VALVE BYPASS USING A NOVEL AUTOMATED DEVICE FOR THE TREATMENT OF HIGH-RISK AORTIC VALVE STENOSIS ON A BEATING HEART
Gabriele Di Giammarco, Carlo Canosa, MD, Massimiliano Foschi, MD.
University of Chieti, Chieti, Italy.

OBJECTIVE: The number of high-risk patients requiring aortic valve replacement is increasing with increased prevalence of comorbidities in the elderly candidates or redo cases.The option of an apico-aortic bypass using valved conduits is not new.We report the results with the use of a novel device incorporating a bioprosthetic stentless valve and designed to be used on a beating heart.
METHODS: From March 2012 to December 2012,11 patient were submitted to aortic-valve bypass(AVB) to treat a severe aortic valve stenosis using a novel system.It is structured into 2 components:a valved conduit incorporating a stentless bioprosthesis to be anastomosed of descending aorta and a ventricular conduit to be implanted on the left ventricular apex using an automated coring device.Patients mean age was 77±7yrs (36% males).Mean ejection fraction (EF) was 53±13%.Mean preoperative NYHA class was 2.3±0.75.The mean LogEUROscore was 16.4±13.6%;Mean EUROscore II was 5,5±3,7%;Mean STS score risk of mortality and morbidity/mortality were respectively 4.3±2.3% and 21.8±5.2%.All the patients received AVB through a mid-lateral thoracotomy.The design of the system makes cardiopulmonary bypass not necessary.In one patient a concomitant left anterior descending(LAD) stenosis was revascularized during the same procedure using a Left Internal Mammary Artery(LIMA) on a beating heart without Cardiopulmonary Bypass.In one patient we planned to use ECMO to support lung function cause of a preoperative severe respiratory failure.
RESULTS: The median duration of the AVB implant was 120 mins(25th-75th percentile 108 - 137).No intraoperative deaths occurred.Mean ICU stay and intubation time were respectively 36.7±18.3 and 18.5±8.72 hours.The mean duration of hospital stay was 11.6±3.77 days.No cerebrovascular accidents occurred.There were two in-hospital deaths,both from hemorrhagic shock not related to operation:a 91yo female who died after liver rupture following a complicated thoracentesis;a 73yo male who died from massive gastrointestinal bleeding.One patient (11%) died 3 months after operation from a undiagnosed, silent hepatic carcinoma.
CONCLUSIONS: AVB with automated ventricular coring system is an alternative to conventional aortic valve replacement in high risk patients in which there is some contraindication to Transcatheter Aortic Valve Implantation(TAVI) procedure or TAVI is not possible for technical reasons.Out of our best knowledge this is the largest single Center experience to now.


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