The application of "microinvasive" approach in cardiac surgery represents a challenge for surgeons and for the whole team. The ability to perform isolated (i.e.: aortic valve replacement; inter-atrial defect closure; mitral valve repair with different devices) or combined cardiac surgical interventions avoiding the use of cardiopulmonary bypass, on-beating heart and with an impressive field (a thorax wide-shut) means overcoming and resetting old clichés. Mitral valve repair with the application of transapical, artificial chordae in a micro-invasive fashion (i.e. Neochord DS1000) enables the correction of DMR in case of leaflet prolapse/flail with no CPB nor aortic CC. This procedure has been recently introduced into clinical practice and has shown promising results. No data about a mid- and long-term follow up of patients treated with this device nor a direct comparison between Neochord (NC) and conventional surgery (CS) in patients with mitral prolapse/flail have been collected and analyzed until now. The main resulting conclusions of our studies are: ¡ NC can be considered a reasonable therapeutic option in patients suffering from severe DMR with favorable anatomy (type A-B) since it provides good early and long-term results up to 5-year in terms of: freedom from severe MR, favourable LV remodeling, relief of symptoms ¡ Patient selection plays a crucial role; patients with unfavorable anatomy should be probably treated by CS ¡ PCI before NeoChord mitral repair procedures is a safe and effective strategy and performing PCI before NeoChord does not affect outcomes in low-risk patients with critical CAD ¡ A combined micro-invasive strategy in selected patients suffering from degenerative MR and CAD should be considered a reasonable alternative to conventional surgery The originality of this work is related not only to a mere data analysis about a "new device", but, above all, it was a "journey" aimed to the application of to a new concept of surgery, intended as a different state-of-mind in clinical practice.
L'applicazione dell'approccio "micro-invasivo" in cardiochirurgia rappresenta una sfida non solo per i chirurghi ma per l'intero team. Realizzare un intervento cardiochirurgico isolato (i.e.: sostituzione valvolare aortica, chiusura di difetto interatriale...) o combinato, evitando la circolazione extra-corporea (CEC) ed il clampaggio aortico (CA), a cuore battente significa risettare il modo di intendere l'approccio agli interventi cardiochirurgici, superando quindi retaggi consolidati. La riparazione valvolare mitralica con l'applicazione di corde artificiali per via transapicale in approccio "micro-invasivo" (i.e. mediante l'utilizzo del device Neochord DS1000) permette la correzione di DMR in caso di leaflet/prolasso senza l'utilizzo di CEC o CA. Questa procedura è stata recentemente introdotta in pratica clinica, mostrando risultati promettenti. Finora non sono mai stati analizzati e resi noti risultati relativi a follow up a medio e lungo termine riguardo pazienti sottoposti a questa procedura. Le principali conclusioni cui siamo giunti sono le seguenti: • NC può essere considerata un'opzione terapeutica ragionevole in pazienti affetti da DMR con insufficienza valvolare severa e con anatomia valvolare favorevole (sottotipo A-B) in quanto ha dimostrato risultati soddisfacenti (fino ad un follow up di 5 anni, il più lungo finora pubblicato a nostra conoscenza) in termini di: libertà da MR recidivante severa, rimodellamento inverso del ventricolo sinistro, miglioramento dei sintomi • la corretta selezione del paziente gioca un ruolo cruciale: pazienti con anatomia valvolare non favorevole (sottotipo C-D) dovrebbero probabilmente essere trattati mediante interventi tradizionali • PCI prima di una procedura NC è un 'opzione sicura ed efficace e non compromette l'outcome dei pazienti a basso rischio ed affetti da coronaropatia critica • una strategia combinata micro-invasiva in pazienti selezionati, affetti da DMR e CAD può essere considerata una valida alternativa al trattamento chirurgico tradizionale L'originalità di questo progetto di ricerca non risiede tanto nella mera analisi di dati relativi ad un nuovo device ma soprattutto è stato "un viaggio" diretto all'applicazione di un nuovo concetto di chirurgia inteso come "state-of-mind" applicato in pratica clinica.
Riparazione mitralica per la patologia valvolare degenerativa: verso l'opzione terapeutica ottimale all'interno dello scenario "micro-invasivo" / Mastro, FLORINDA ROSARIA. - (2023 Mar 08).
Riparazione mitralica per la patologia valvolare degenerativa: verso l'opzione terapeutica ottimale all'interno dello scenario "micro-invasivo"
MASTRO, FLORINDA ROSARIA
2023
Abstract
The application of "microinvasive" approach in cardiac surgery represents a challenge for surgeons and for the whole team. The ability to perform isolated (i.e.: aortic valve replacement; inter-atrial defect closure; mitral valve repair with different devices) or combined cardiac surgical interventions avoiding the use of cardiopulmonary bypass, on-beating heart and with an impressive field (a thorax wide-shut) means overcoming and resetting old clichés. Mitral valve repair with the application of transapical, artificial chordae in a micro-invasive fashion (i.e. Neochord DS1000) enables the correction of DMR in case of leaflet prolapse/flail with no CPB nor aortic CC. This procedure has been recently introduced into clinical practice and has shown promising results. No data about a mid- and long-term follow up of patients treated with this device nor a direct comparison between Neochord (NC) and conventional surgery (CS) in patients with mitral prolapse/flail have been collected and analyzed until now. The main resulting conclusions of our studies are: ¡ NC can be considered a reasonable therapeutic option in patients suffering from severe DMR with favorable anatomy (type A-B) since it provides good early and long-term results up to 5-year in terms of: freedom from severe MR, favourable LV remodeling, relief of symptoms ¡ Patient selection plays a crucial role; patients with unfavorable anatomy should be probably treated by CS ¡ PCI before NeoChord mitral repair procedures is a safe and effective strategy and performing PCI before NeoChord does not affect outcomes in low-risk patients with critical CAD ¡ A combined micro-invasive strategy in selected patients suffering from degenerative MR and CAD should be considered a reasonable alternative to conventional surgery The originality of this work is related not only to a mere data analysis about a "new device", but, above all, it was a "journey" aimed to the application of to a new concept of surgery, intended as a different state-of-mind in clinical practice.File | Dimensione | Formato | |
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