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| | __NOTOC__ |
| | {| class="infobox" style="float:right;" |
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| | | [[File:Siren.gif|30px|link=Aortic stenosis resident survival guide]]|| <br> || <br> |
| | | [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
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| {{Aortic stenosis surgery}} | | {{Aortic stenosis surgery}} |
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| '''For the WikiPatient page for this topic, click [[Aortic valve surgery (patient information)|here]]'''; '''For the main page of aortic stenosis, click [[Aortic stenosis|here]]''' | | '''For the WikiPatient page for this topic, click [[Aortic valve surgery (patient information)|here]]''' |
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| {{CMG}}; '''Associate Editors-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]][mailto:msbeih@perfuse.org]; Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu]; [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com]; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh@perfuse.org]; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@perfuse.org] | | '''For the WikiDoc page of Aortic stenosis, click [[Aortic stenosis|here]]''' |
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| | {{CMG}}; '''Associate Editors-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]][mailto:msbeih@wikidoc.org]; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]; {{USAMA}} '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] |
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| ==[[Aortic stenosis surgery overview|Overview]]== | | ==[[Aortic stenosis surgery overview|Overview]]== |
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| | ==[[Aortic stenosis surgery epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Aortic stenosis surgery indications|Indications]]== | | ==[[Aortic stenosis surgery indications|Indications]]== |
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| ==[[Aortic stenosis surgery recovery|Recovery]]== | | ==[[Aortic stenosis surgery recovery|Recovery]]== |
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| ==[[Aortic stenosis surgery prognosis|Outcomes & Prognosis]]== | | ==[[Aortic stenosis surgery prognosis|Outcomes and Prognosis]]== |
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| ==[[Aortic stenosis surgery complications|Complications]]== | | ==[[Aortic stenosis surgery complications|Complications]]== |
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| ==[[Aortic stenosis surgery videos|Videos]]== | | ==[[Aortic stenosis surgery videos|Videos]]== |
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| ==Overview==
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| Surgical intervention may be a necessary component of treatment for symptomatic severe aortic stenosis. Aortic valve replacement is the mainstay of treatment of symptomatic aortic stenosis (AS), as it improves both the symptoms and life expectancy in aortic stenosis patients, in contrast to medical therapy alone which may improve the symptoms without prolonging life expectancy. Intervention methods may include:
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| *Aortic valve replacement, mechanical and device based therapies such as bileaflet mechanical aortic valves.
| | [[CME Category::Cardiology]] |
| *Aortic Balloon Valvotomy, aortic valvuloplasty (aortic valve repair).
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| ==Mechanical and device based therapy==
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| Aortic stenosis requires [[aortic valve replacement]] if medical management does not successfully control symptoms.
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| According to a prospective, single-center, nonrandomized study of 25 patients, percutaneous implantation of an aortic valve prosthesis in high risk patients with aortic stenosis results in marked hemodynamic and clinical improvement when successfully completed.<ref>{{cite journal |author=Grube E, Laborde JC, Gerckens U, ''et al'' |title=Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study |journal=Circulation |volume=114 |issue=15 |pages=1616-24 |year=2006 |pmid=17015786 |doi=10.1161/CIRCULATIONAHA.106.639450}}</ref>
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| '''Bileaflet mechanical aortic valve'''
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| <googlevideo>4541951625687665949&hl=en</googlevideo>
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| ==Aortic valvuloplasty==
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| ===Patient selection and treatment choices===
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| * Surgical Aortic valve replacement is the treatment of choice for aortic stenosis but many patients are not good candidates due to advanced age and multiple co-morbidities
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| * Percutaneous aortic valve replacement is in its infancy and thus aortic valvuloplasty can offer palliation of symptoms and potentially prolong survival for these high risk patients in class III-IV heart failure
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| * It can be performed emergently in patients with end-stage heart failure due to aortic stenosis: patients in cardiogenic shock, as a bridge to aortic valve replacement, patients with critical aortic stenosis needing emergent non-cardiac surgery, poor surgical candidates and nonagenerians, patients with congenital or rheumatic aortic stenosis
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| * Results usually last 6 months up to 2 years (with repeat procedures possible if aortic regurgitation is not severe)
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| * Valvuloplasty tends to alleviate heart failure symptoms and improve hemodynamics but rarely does it alleviate angina
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| ====Technique====
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| The retrograde technique is the most commonly used technique.
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| *8 French femoral sheath can usually accommodate a 20 mm balloon and minimizes vascular complications
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| *Alternatively two 6 Fr sheath from bilateral femoral approach and two smaller balloons can be used
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| *The letter may be necessary in female elderly patients with concomitant peripheral vascular disease
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| *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
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| *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
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| *The 20-23 mmX 6 cm balloon is advance over the wire and positioned to straddle the aortic valve
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| *The balloon is manually inflated with a 60 cc syringe containing diluted contrast (slowly)
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| *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
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| ==Complications==
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| Complications stemming from aortic stenosis surgical therapies primarily involve vascular complications.
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| 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.
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| ==External Links==
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| | [[Category:Disease]] |
| | [[Category:Valvular heart disease]] |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| | [[Category:Congenital heart disease]] |
| | [[Category:Cardiac surgery]] |
| [[Category:Surgery]] | | [[Category:Surgery]] |
| [[Category:Cardiac surgery]]
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| [[Category:Surgical procedures]]
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| [[Category:Overview complete]]
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| [[Category:Template complete]]
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| [[Category:For review]]
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| [[Category:Mature chapter]]
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| {{WH}}
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| {{WS}}
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