Bonaros Nikolaos, Özpeker Cenk, Kofler Markus, Dumfarth Julia, Holfeld Johannes, Schachner Thomas, Müller Ludwig, Grimm Michael
Department of Cardiac Surgery, Medical University of Innsbruck.
Medical University of Innsbruck University Clinic of Cardiac Surgery Anichstrasse 35 6020, Innsbruck.
Multimed Man Cardiothorac Surg. 2018 Jan 30;2018. doi: 10.1510/mmcts.2018.010.
Bioprosthetic aortic valves have been used with increasing frequency over the past two decades, often in relatively young patients who may eventually require aortic valve re-operations due to degeneration of the bioprosthesis. Growing experience with minimally invasive aortic valve replacement has prompted surgeons to use minimally invasive approaches also with redo operations for replacement of the aortic valve. This tutorial describes the operative steps for a minimally invasive redo replacement of the aortic valve through an upper ministernotomy. We demonstrate the surgical access, initiation of cardiopulmonary bypass, venting, and cardioplegia strategies. Special situations, such as how to approach patent coronary grafts, the small aortic annulus, and the use of sutureless or rapid deployment valves are demonstrated and discussed. The tutorial shows that minimally invasive redo aortic valve replacement is a safe, effective, and reproducible procedure.
在过去二十年中，生物人工主动脉瓣的使用频率越来越高，常用于相对年轻的患者，这些患者最终可能因生物人工瓣膜退变而需要再次进行主动脉瓣手术。随着微创主动脉瓣置换经验的不断积累，外科医生也开始在主动脉瓣再次置换手术中采用微创方法。本教程描述了通过上半部分胸骨切开术进行微创主动脉瓣再次置换的手术步骤。我们展示了手术入路、体外循环的启动、排气以及心脏停搏策略。还展示并讨论了特殊情况，例如如何处理通畅的冠状动脉移植物、小主动脉瓣环以及无缝合或快速植入瓣膜的使用。本教程表明，微创主动脉瓣再次置换是一种安全、有效且可重复的手术。
