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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 TAVR

In my quest to facilitate and simplify minimally invasive, right mini-thoracotomy aortic valve surgery over the past 11 years, I have tried many different techniques and devices.

I believe that the aortic cuff  (Miami Instruments, Miami, FL) significantly facilitates and improves the exposure necessary to perform an expeditious and safe operation.

I am constantly asked how is it that I insert the aortic cuff. Due to this, I have decided to make a short You tube video. This is the current and most effective way to insert the cuff.

Of note, patients that have a heavily calcified aortic root may not be good candidates for insertion of the cuff. The cuff needs a semi compliant aorta in order for it to expand inside the root.

There may also be difficulty with insertion of the cuff in patients with a bicuspid aortic valve.  In these patients, with fusion of the left and right cusps, I will place the cuff through the commissural stay suture between the left and right cusp. (Normally it will be placed through the suture between that left and non-coronary cusps). This is not always perfect but does help. If the cuff slips in these cases, I will remove it.

There are also a small group of patients who can have the procedure performed without a cuff because visibility is adequate.

Insertion of Aortic Cuff  (you can click this link or copy and paste the link below)

 

 

I have enclosed a link to the Annals of Cardiothoracic Surgery.
I have submitted 4 publications to this journal that I would like for all of you to review.
Two are relevant to Minimally Invasive AVR/MVR, one on Minimally Invasive AVR, and one on Building a Minimally Invasive Valve Program, of which I was a co-author with Dr. Tom Nguyen.
In addition, I think that all of the contributions to this journal are significant and will help advance the subspecialty of minimally invasive valve surgery.
I urge all to subscribe.
There are previous editions of this journal which are excellent and I believe serve as a reference for all Cardiothoracic Surgeons.
www.annalscts.com

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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