A Bright Future: 50+ Video Guided Right Anterior Mini-Thoracotomy Aortic Valve Replacements, Including the First-In-Man Use of Automated RAM® Annular Suturing Technology (Supported by LSI Solutions)
Dr. Peter A. Knight
University of Rochester Medical Center
Cardiac surgeons believed that the structural heart arena would always be theirs. Reminiscent of coronary revascularization, percutaneous access ASD and PFO closures by interventional cardiologists heralded another new era of non-surgical therapy. With the advent of TAVR, aortic valve surgery is at a critical juncture. For cardiac surgeons to remain relevant, less invasive surgery must be developed, and quickly. Surgeons must lead or accept obsolescence. Transcatheter aortic valve interventions will replace surgery, if surgery does not become substantially better. Patients demand and deserve more convenience, less pain and better outcomes. While TAVR data are encouraging for the first few years, by five years, supportive evidence is weak and less promising. Excellent truly minimally invasive surgery must offer myriad advantages beyond optimal durability: freedom from PVLs and low gradients; low risk of permanent pacemaker; sternum, cartilage and rib sparing access; reduced CPB and cross-clamp times; extubation in the OR; low risk for transfusion; rapid transition out of intensive care and the hospital; prompt return to normal activities and home even for the morbidly obese; all with minimal discomfort and excellent cosmesis. For a revolutionary surgical advance to become broadly disseminated and accepted, it must be teachable, reproducible and minimize the need for femoral access, while providing results even better than open surgery.
In my practice at the University of Rochester Medical Center, all isolated AVR patients are booked as Miniís. This presentation will provide insight into how we built this program, designed the operation and offer the lessons learned along the way. Video guided mini-thoracotomy AVRs are now our routine. This platform works well for other procedures, such as annular enlargement and subaortic membrane resection. Customized innovations for cardiac surgery offer even more reason for excitement, as is illustrated in our recent First-In-Man use of automated, single squeeze RAM® technology for annular suturing. The future of heart surgery is indeed bright for surgeons willing and able to provide the very best outcomes for their patients.
Trifecta Valve Mid-Term Durability Ė Multicenter Trial Update
(Supported by St. Jude Medical)
Dr. Mark Groh
Mission Hospital in Asheville, North Carolina, USA
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