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Cabrucci F, Sicouri S, Baudo M, Magouliotis DE, Yamashita Y, Bacchi B, Petrone D, Wasef B, Dokollari A, Bonacchi M, Ramlawi B. Not All SAVR Are Created Equal: All the Approaches Available for Surgical Aortic Valve Replacement. J Cardiovasc Dev Dis 2025; 12:84. [PMID: 40137082 PMCID: PMC11942817 DOI: 10.3390/jcdd12030084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 02/21/2025] [Accepted: 02/22/2025] [Indexed: 03/27/2025] Open
Abstract
Surgical Aortic Valve Replacement (SAVR) is still one of the pillars of cardiac surgery practice, and its role is evolving into a more complex operation. The competition with structural valve therapies and the urgent demand for less invasive solutions have unleashed surgeons' creativity in adapting to these new challenges. All the possible ways to surgically replace the aortic valve are analyzed in this review. Surgical techniques, advantages and disadvantages, and key differences are listed, helping surgeons navigate the available options. Sternotomy SAVR is the benchmark, but that is becoming obsolete and, in some cases, no longer performed for teaching purposes. Mini sternotomy is the easiest way to achieve minimal invasiveness in all anatomic situations, while right anterior thoracotomy is an elegant solution mastered by fewer surgeons. Endoscopic and robotic-assisted techniques are shaping the future of SAVR, yet they still lack wide adoption. The choice of approach is mainly dictated by the anatomic features of the patient and the surgeon's skills. A flow diagram to overcome the learning curve and advance toward more complex surgery is provided here. Mastering as many techniques as possible is paramount when offering a patient-tailored approach and performing a safe and less invasive operation.
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Affiliation(s)
- Francesco Cabrucci
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (M.B.); (D.E.M.); (Y.Y.); (B.W.); (B.R.)
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (M.B.); (D.E.M.); (Y.Y.); (B.W.); (B.R.)
| | - Massimo Baudo
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (M.B.); (D.E.M.); (Y.Y.); (B.W.); (B.R.)
| | - Dimitrios E. Magouliotis
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (M.B.); (D.E.M.); (Y.Y.); (B.W.); (B.R.)
| | - Yoshiyuki Yamashita
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (M.B.); (D.E.M.); (Y.Y.); (B.W.); (B.R.)
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA
| | - Beatrice Bacchi
- F.U. Cardiac Surgery Department, AOU Careggi University Hospital, 50127 Firenze, Italy; (B.B.); (D.P.); (M.B.)
| | - Dario Petrone
- F.U. Cardiac Surgery Department, AOU Careggi University Hospital, 50127 Firenze, Italy; (B.B.); (D.P.); (M.B.)
| | - Beman Wasef
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (M.B.); (D.E.M.); (Y.Y.); (B.W.); (B.R.)
| | - Aleksander Dokollari
- Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB R2H 2A6, Canada;
| | - Massimo Bonacchi
- F.U. Cardiac Surgery Department, AOU Careggi University Hospital, 50127 Firenze, Italy; (B.B.); (D.P.); (M.B.)
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA; (S.S.); (M.B.); (D.E.M.); (Y.Y.); (B.W.); (B.R.)
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA 19096, USA
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Vervoort D, An KR, Deng MX, Elbatarny M, Fremes SE, Ouzounian M, Tarola C. The Call for the "Interventional/Hybrid" Aortic Surgeon: Open, Endovascular, and Hybrid Therapies of the Aortic Arch. Can J Cardiol 2024; 40:478-495. [PMID: 38052303 DOI: 10.1016/j.cjca.2023.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Aortic arch pathology is relatively rare but potentially highly fatal and associated with considerable comorbidity. Operative mortality and complication rates have improved over time but remain high. In response, aortic arch surgery is one of the most rapidly evolving areas of cardiac surgery in terms of surgical volume and improved outcomes. Moreover, there has been a surge in novel devices and techniques, many of which have been developed by or codeveloped with vascular surgeons and interventional radiologists. Nevertheless, the extent of arch surgery, the choice of nadir temperature, cannulation, and perfusion strategies, and the use of open, endovascular, or hybrid options vary according to country, centre, and surgeon. In this review article, we provide a technical overview of the surgical, total endovascular, and hybrid repair options for aortic arch pathology through historical developments and contemporary results. We highlight key information for surgeons, cardiologists, and trainees to understand the management of patients with aortic arch pathology. We conclude by discussing training paradigms, the role of aortic teams, and gaps in knowledge, arguing for the need for wire skills for the future "interventional aortic surgeon" and increased research into techniques and novel devices to continue improving outcomes for aortic arch surgery.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin R An
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mimi X Deng
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Tarola
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Bonacchi M, Bacchi B, Cabrucci F, Tevaearai Stahel H, Jeenchen Chen R, Dokollari A. Editorial: Insights in heart surgery: 2022. Front Cardiovasc Med 2023; 10:1184097. [PMID: 37139120 PMCID: PMC10150089 DOI: 10.3389/fcvm.2023.1184097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Massimo Bonacchi
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | - Beatrice Bacchi
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | - Francesco Cabrucci
- Cardiac Surgery F.U., Experimental and Clinical Medicine Department, University of Florence, Firenze, Italy
| | | | - Robert Jeenchen Chen
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, United States
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