Cerebral Protection System In Less Invasive Surgery: Transferring Percutaneous Technologies Into Surgical Practice
Filippo Capestro, Paolo Berretta, Mariano Cefarelli, Jacopo Alfonsi, Alessandro D'alfonso, Carlo Zingaro, Michele Danilo Pierri, Marco Di Eusanio.
Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy.
BACKGROUNDPatients with severe aortic valve stenosis are currently treated with 2 different interventional techniques namely surgical (SAVR) or transcatheter aortic valve replacement (TAVR). While TAVR is commonly preferred over SAVR in patients with porcelain or severely calcified aorta, the lack of data on valve durability raises concerns on its use in young patients. Here we present our minimally invasive approach for SAVR with the use of a percutaneous cerebral protection system (CPS) commonly employed during TAVR.METHODSOur approach for SAVR involves reduced incisions, rapid deployment valves, minimally invasive extracorporeal circulation (MiECC) and ultra-fast track anaesthesia. It is supplemented by the use of CPS in young, low-risk patients presenting with severely calcified ascending aorta. After ministernotomy, 2 clips are placed at the base of the arch vessels as radiological markers. The CPS is positioned through the right radial artery under fluoroscopic control, leaving the filters in the innominate and left common carotid arteries. The left axillary artery is cannulated for MiECC inflow to reverse the blood flow in the left subclavian artery and further minimize the patient's embolic risk. Rapid deployment SAVR is performed in the standard fashion. The CPS is then removed before protamine administration.RESULTSMini SAVR with CPS was performed in three patients. The examination of the filters showed little debris captured from the device in 2 cases. All patients were extubated in the operating room without neurological deficits. No death or neurological complication occurred within 30 days. CONCLUSIONSOur experience suggests that CPS can be easily transferred into surgeons' hands in order to improve operative results and neurological outcomes. We believe that surgeons must actively adopt catheter-based technologies to have the unique potential to offer truly individualized treatment options, superior outcomes and safest management of complications.
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