How i teach itTranscatheter Aortic Valve Replacement: How I Teach It
Section snippets
Preparation
We find teaching TAVR to be much different from teaching our other surgical procedures. Cardiac surgeons are exposed both to imaging modalities that they do not normally use and to a set of tools and vocabulary that can be foreign to their normal practice.
We begin, just as with our open surgical procedures, with proper patient selection. The physiologic indications for valve replacement are no different for TAVR than SAVR: TAVR should only be considered for patients appropriate for a tissue
How I Teach It
After the appropriate patient and valve are selected, the procedure itself divides into several easy-to-remember steps: access, valve crossing and balloon aortic valvuloplasty, valve implantation, and closure. Additional considerations are local anesthesia with sedation versus general anesthesia and placement of a temporary pacing wire. The majority of our cases are performed with the patient awake, with sedation and anesthesia places as temporary screw-in leads from the right jugular vein.
Comment
Transcatheter aortic valve replacement is already an extremely important part of any structural heart program and likely to increase in use. It is crucial for cardiac surgeons to be knowledgeable of and skilled in this technique to move their programs forward, and as an entree into the coming transcatheter approaches to other valves.
References (4)
- et al.
Evaluation of patients with severe symptomatic aortic stenosis who do not undergo aortic valve replacement: the potential role of subjectively overestimated operative risk
Circ Cardiovasc Qual Outcomes
(2009) - et al.
Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description
Circulation
(2002)
Cited by (2)
Surgical Removal and Replacement of Chronically Implanted Transcatheter Aortic Prostheses: How I Teach It
2018, Annals of Thoracic SurgeryA safe and simple technique for crossing stenotic aortic valves
2021, Clinical Research in Cardiology