By Ottavio Alfieri, Michele De Bonis, Giovanni La Canna
This is the 1st entire evaluation of the edge-to-edge procedure for mitral fix, which was once brought into the surgical armamentarium in 1991 via one of many authors, Ottavio Alfieri. The surgical process hired in edge-to-edge fix this present day offers the root for the single trustworthy approach to percutaneous correction of degenerative mitral regurgitation. The e-book strains the evolution of the edge-to-edge method from a surgical to a percutaneous strategy, documenting symptoms, contraindications, technical facets, controversies and scientific results. precise realization is dedicated to the MitraClip strategy, which reproduces the Alfieri sew percutaneously and has up to now been utilized in greater than 20,000 sufferers world wide. The state-of-the-art in MitraClip treatment is defined, with transparent clarification of whilst and the way to take advantage of the MitraClip approach. The reader will research all points of percutaneous edge-to-edge fix, that's advised to be used in conscientiously chosen sufferers within the new ESC/EACTS instructions for the administration of valvular center disorder and within the ESC directions on middle failure. the crowd at San Raffaele health center, Milan, has gathered by way of some distance the most important event on the earth with the procedure and through the years has been very energetic in its merchandising and medical evaluate. This publication displays that intensity of information and should be of significant curiosity to cardiac surgeons and interventional and medical cardiologists.
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Extra resources for Edge-to-Edge Mitral Repair: From a Surgical to a Percutaneous Approach
This method has been shown to have excellent long-term outcomes in patients with both simple or complex degenerative mitral disease. In many instances anterior leaflet repairs have been less reproducible with other techniques, such as resections, chordal shortening, and chordal transpositions. Bileaflet prolapse remains additionally challenging for many surgeons. Prolonged aortic cross clamp times have been associated with bileaflet prolapse repairs. Thus, the EE technique has a great potential in both minimally invasive robotic and invasive mitral repairs that tend to have longer perfusion and arrest times.
One patient required a pacemaker before discharge. 3 days with 46 % being discharged within 5 days of surgery. Conclusions Although the edge-to edge technique has not been the mainstay of our mitral repair armamentarium, we have found it very effective in selected patients. The technique is applied easily to robotic technology. The superior instrument articulation and vision with robotics provide an optimal way to apply the EE through the least invasive incisions. Professor Alfieri proved the long-term efficacy of this method, and robotic cardiac surgeons should put the EE in their operative “toolbox” either as their primary repair choice or for selected patients.
1 Anesthesia and Cannulation Our cardiopulmonary bypass (CPB) cannulation, perfusion, and myocardial protection techniques have been published in detail . With the patient in the supine position, either a double lumen endotracheal tube or bronchial blocker is inserted. Then, the 3-D trans-esophageal echocardiographic probe is positioned and detailed studies are completed. A thermo-dilution Swan–Ganz™ (SG) pulmonary artery catheter (Edwards Lifesciences, Irvine, Calif) is placed via the right internal jugular vein.
Edge-to-Edge Mitral Repair: From a Surgical to a Percutaneous Approach by Ottavio Alfieri, Michele De Bonis, Giovanni La Canna