Aortic stenosis surgery: Difference between revisions
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Revision as of 20:07, 30 November 2011
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Aortic stenosis surgery | |
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Treatment | |
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Aortic stenosis surgery On the Web | |
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American Roentgen Ray Society Images of Aortic stenosis surgery | |
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Risk calculators and risk factors for Aortic stenosis surgery | |
For the WikiPatient page for this topic, click here; For the main page of aortic stenosis, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Mohammed A. Sbeih, M.D.[2]; Claudia P. Hochberg, M.D. [3]; Abdul-Rahman Arabi, M.D. [4]; Keri Shafer, M.D. [5]; Priyamvada Singh, MBBS [6]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [7]
Overview
Indications
Preoperative Evaluation
Procedure
Recovery
Outcomes & Prognosis
Complications
Videos
Technique
The retrograde technique is the most commonly used technique.
- 8 French femoral sheath can usually accommodate a 20 mm balloon and minimizes vascular complications
- Alternatively two 6 Fr sheath from bilateral femoral approach and two smaller balloons can be used
- The letter may be necessary in female elderly patients with concomitant peripheral vascular disease
- 0.035” straight wire is commonly used to cross the valve and advance via pig-tail or Amplatz catheter; Right heart catheterization is done and transaortic gradient is typically measured pre-procedure
- The 0.035” wire is then exchanged for a stiffer 0.038”Amplatz exchange length wire with the tip shaped into a pig-tail shape so as not to injure the LV
- The 20-23 mmX 6 cm balloon is advance over the wire and positioned to straddle the aortic valve
- The balloon is manually inflated with a 60 cc syringe containing diluted contrast (slowly)
- Meticulous control of balloon position must be maintained at all times by backward traction on the balloon to prevent jumping forward and injuring/perforating the LV apex
Complications
Complications stemming from aortic stenosis surgical therapies primarily involve vascular complications.
The most preferable surgical closure method for this tenuous patient population is a perclose or angioseal closure. This particular closure method calls for a mandatory attention to the meticulous access technique. An antegrade approach may be a viable method in some patient populations. An example of such would be the venuous access with transseptal approach. This particular procedure can be done in a select population of patients. Many patients experience an adverse response to the hemodynamic effect of mitral valve incompetence. In this situation, the rigidity of the wire traveling across the mitral valve can directly result in mitral valve injury. It is, therefore, not an advisable treatment method for most populations.