Surgeons in France report that they have performed the very first complete endoscopic aortic valve replacement (TEAVR) in 2 human patients. Their paper has been published in the the Journal of Thoracic and Cardiovascular Surgery [subscription required].
In latest many years the development of TAVR (transcatheter aortic valve replacement) has attracted enormous focus. But TAVR, which is carried out by an interventional cardiologist, is generally restricted to patients who are either not appropriate for surgical procedure or at extremely higher risk for surgery. The new paper is the most recent indication that surgeons also are now doing work to restrict as much as feasible the trauma of aortic valve surgical procedure.
The new process could allow surgeons to change the aortic valve without having opening the chest, even though it will nonetheless require cardiopulmonary bypass and excision of the old valve. The essential to the new procedure is the latest availability of sutureless aortic valve bioprostheses, in this situation the Medtronic 3f Allow bioprosthesis. In current many years these gadgets have allowed surgeons to build “minimally invasive” surgical techniques. The new report is about the very first surgical method in which the chest is not opened and the method is carried out totally by way of endoscopes. The authors pointed out that 1 advantage of TEAVR is that it is really straightforward to convert to a much more traditional open surgical procedure if it gets needed.
The two patients have been 82 and 93 years of age and had aortic valve stenosis. The patients spent about 2 and 1/two hours under cardiopulmonary bypass, but the real implantation of the device took only 45 minutes. Both individuals have been discharged from the hospital in a week and have had no severe complications.
The authors said that the procedure occasions were “acceptable” and that they think the studying curve for TEAVR could be shorter than for completely endoscopic bypass surgical procedure. They further anticipate that advances in engineering will lead to a lot more productive procedures.
The lead author of the paper, Marco Vola, a cardiovascular surgeon in Saint-Etienne, France, mentioned the improvement of the procedure in a press release issued by the journal: “In our institution, we started by adopting the mini-sternotomy strategy, involving a tiny incision via the sternum, as regimen. We then transitioned to the correct mini-thoracotomy technique, involving a small incision by way of the thorax, very first beneath direct see, then with an endoscopic camera. Finally we adopted a entirely endoscopic method.”
“These 1st procedures show that totally endoscopic sutureless aortic valve replacement is technically feasible,” he stated. “Further clinical expertise and technical development are essential to shorten operation occasions and to assess further the prospective postoperative benefits of TEAVR.”