Aortic valve bypass: experience from Denmark

• Published in: Interactive cardiovascular and thoracic surgery 2013-07, Vol.17 (1), p.79-83
• Main Authors: Lund, Jens T., Jensen, Maiken B., Arendrup, Henrik, Ihlemann, Nikolaj
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta - physiopathology; Aorta - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Denmark; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - methods; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Humans; Male; Original; Patient Selection; Prosthesis Design; Risk Factors; Time Factors; Treatment Outcome; Ultrasonography
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt087

OBJECTIVES In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI). During the last one and a half year, 10 patients otherwise left for medical therapy have been offered this procedure. We present the Danish experiences with the AVB procedure with a focus on patient selection, operative procedure and short-term results. METHODS AVB is performed through a left thoracotomy. A 19-mm Freestyle® valve (Medtronic) is anastomosed to a vascular graft and an apex conduit. The anastomosis to the descending aorta is made prior to connecting the conduit to the apex. In 1 patient, we used an automated coring and apical connector insertion device (Correx®). The device results in a simultaneous coring and insertion of an 18-mm left ventricle connector in the apical myocardium. AVB is routinely performed without circulatory assistance. RESULTS Ten patients have been operated on since April 2011: eight females and 2 males with a median age of 76 (65-91) years. Seven patients had a severely calcified ascending aorta. Three of these had previously had a sternotomy, but did not have an AVR because of porcelain aorta. Six patients had a very small left ventricle outflow tract (