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Miami Minimally Invasive Valves
Joseph Lamelas, MD
Dedicated to the Advancement of Minimally Invasive Cardiac Surgery
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Posts tagged as TAVI

http://www.medscape.org/viewarticle/760718?t=1

I came across this interview that Dr. Michael Moront and I participated in during an STS meeting 2 years ago in Ft. Lauderdale.

Despite being 2 years old, the concepts still hold true.

Check it out !!!

 

Another reason to become comfortable with the mini – thoracotomy AVR’S is that it prepares you for a direct aortic TAVR.   This  DIRECT AORTIC access for a TAVR was performed via 3-4 cm mini-thoracotomy without rib dislocation. The 18 Fr. sheath was passed through a separate incision.  There is obviously a need for the sheath’s to be made shorter as well as the delivery device.

Becoming comfortable with this access will also prepare you for the sutureless valve implants.

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I constantly hear that obese patients are not candidates for Minimally Invasive Surgery.  I truly believe that these are the ones that benefit the most. They ambulate sooner  due to improved chest wall stability. Physical therapy as well as pulmonary toilet is facilitated. In addition, the risk of sternal complications does not exist. I also have heard that the CT scan is essential in determining who is a candidate for a minimally invasive AVR. This is NOT true. I have enclosed a CT scan on a patient that I recently operated upon.( I do not order CT scans, but since she was being evaluated for a TAVR, it was performed).  As you can clearly see, her aorta on the the left side of the chest. Some would say that this is a contraindication. Some even draw a line from the mid portion of the sternum and trace it back to the spine. If the aorta is to the left, then this is an exclusion criteria for a mini AVR. This is absolutely WRONG!!!  In my experience, if the heart is further away from the chest wall, the visualization will be better. I have operated on many very obese patients, and the surgery has been easier than in some very slender patients. 

This is an 83 y/o very obese ,wheelchair bound, O2 dependent female with multiple hematologic problems (which excluded her from being Corevalve candidate) as well as pulmonary issues and an IVC filter which was crossed with the 25 Fr. Biomedicus venous cannula. (FYI, I have been able to cross all but one of 12 Vena cava filters!)DSCN8607DSCN8628 DSCN8571 DSCN8576 DSCN8619who have critical AS.