Surgeons perform first totally endoscopic aortic valve substitute
For aortic valve replacement, cardiovascular surgeons usually have to make a large cut in the patient’s chest. But this may be a thing of the past; for the first time, surgeons in France have successfully replaced the aortic valve in two patients without opening their chest during surgery.
Research detailing the process, transported out using totally endoscopic aortic valve substitute (TEAVR), continues to be printed within the Journal of Thoracic and Cardiovascular Surgery.
The scientists, brought by Dr. Marco Vola from the Department of Cardiovascular Surgery in the Center Hospitalier Universitaire de Saint-Etienne in France, say their findings reveal that TEAVR can improve the caliber of existence for heart patients by reduction of chest trauma.
Cardiovascular surgeons already use endoscopic surgery for a lot of heart methods, including heart bypass grafting and atrial septal defect repair.
In comparison along with other techniques, endoscopic surgery results in faster time to recover for patients and it is less painful, meaning their quality of existence after the process is enhanced.
How was the TEAVR procedure carried out?
The research team says that until now, using TEAVR had not been feasible as the required stented tissue valves were not available.
The picture above shows each step of the TEAVR procedure. Surgeons were able to use the technique to replace the aortic valve of two patients without having to open their chest during surgery.
Image credit: American Association for Thoracic Surgery
However the recent introduction of sutureless bioprostheses for aortic valves which are installed on a compressible self-broadened nitinol (nickel titanium) stent permitted the surgeons to handle the process.
Explaining the way the surgeons completed the aortic valve substitute in every patient, Dr. Vola states they started using the small-sternotomy technique. This requires a little cut with the sternum (breastbone).
Then they transported out a small-thoractomy, concerning a little cut with the throrax. The surgeons did this under direct view before altering to using an endoscopic camera. The relaxation from the procedure, which incorporated the implantation from the stent, ended utilizing a totally endoscopic technique.
“You should observe that when carrying out TEAVR, a fast and safe conversion to small-thoracotomy under direct view can be created if conditions demand. This could still offer considerably reduced chest trauma,” describes Dr. Vola.
The process required under forty-five minutes for every patient.
The future of TEAVR
The detectives observe that when testing totally endoscopic surgery in other fields, the process involved longer cardiopulmonary bypass (CBP) time. CBP involves someone being linked to a piece of equipment that temporarily gets control the part of the heart and lung area during surgery.
In addition, totally endoscopic surgery elevated how long an aortic mix-clamp was utilized – a surgical instrument that clamps the aorta and separates the systemic circulation in the output from the heart.
But the researchers say they believe longer CBP and clamping time is acceptable and that the testing periods for TEAVR could be shorter than the testing period reported for totally endoscopic coronary artery bypass grafting.
However, there’s still a method to go before TEAVR is really a broadly used surgical treatment for heart patients.
The detectives say enhancements towards the technique are needed, including the introduction of second-generation sutureless bioprostheses to simplify implantation.
But Dr. Vola states the team’s findings reveal that TEAVR is “technically achievable.” He adds:
“Further clinical experience and technical development are necessary to shorten operation times and to assess further the potential postoperative benefits of TEAVR.”