The aortic valve can be replaced without sternum. Uncle a, 64, has been troubled for eight years

Aortic valve malformation with stenosis, dilated cardiomyopathy, heart failure These diseases also appeared in the 64 year old Zhang Shu, making his every move very difficult.

aortic valve replacement and thoracotomy? At the thought of such an operation, Zhang Shu was afraid. Unexpectedly, the doctor successfully completed the operation through a small incision of a few centimeters.

on August 2, Professor Yan Yusheng, director of Cardiology and macrovascular surgery, Zhujiang Hospital, Southern Medical University, performed minimally invasive transapical aortic valve replacement for Uncle Zhang. With the advantages of small trauma and quick recovery, Uncle Zhang was free from the pain of “chest opening” and successfully regained his “heart” life.

Uncle Zhang has been suffering from chest tightness and shortness of breath for seven or eight years, but most of them used to breathe heavily when climbing stairs and exercising. Take some medicine and take more rest. I didn’t expect that this year, the situation has suddenly become serious. Sitting still and lying on one’s back will cause shortness of breath. I can’t sleep safely. I can’t wake up in two or three hours.

the examination results showed that Zhang Shu had bicuspid aortic valve malformation with stenosis and reflux, dilated cardiomyopathy, cardiac function grade IV – the highest level of heart failure. The EF value is only 25%.

Professor Yan Yusheng explained that the aortic valve is located between the left ventricle and the ascending aorta and mainly acts as a one-way valve. When the heart contracts, it opens so that the blood flow from the left ventricle can flow smoothly into the ascending aorta; when the heart relaxes, it closes to ensure that blood does not return to the left ventricle.

if aortic disease or malformation occurs, left ventricular ejection difficulty, blood reflux, will lead to the decline of cardiac function, systemic blood supply insufficiency, patients will appear dizziness, fatigue, chest tightness, shortness of breath, palpitation, and severe heart failure, cardiogenic shock and even sudden death.

for patients like Uncle Zhang, aortic valve replacement is an inevitable choice. Under cardiopulmonary bypass, sawing the sternum for aortic valve replacement is the most commonly used method. However, due to Uncle Zhang’s older age, poor cardiac function, and dilated cardiomyopathy, he can’t tolerate conventional extracorporeal circulation surgery, and I also resist because of my old age.

after multi-disciplinary consultation and careful consideration of family members, Professor Yan Yusheng’s team decided to implement minimally invasive transapical aortic valve replacement for Uncle Zhang.

what kind of operation is transapical TAVR? Professor Yan Yusheng explained that it is a minimally invasive valve replacement operation, which only needs to open a small opening of about 3-5cm in the left anterior chest, and deliver the artificial heart valve to the position of the aortic valve through the small hole at the apex of the heart through the interventional technology to replace the original valve function.

what are the advantages of transapical TAVR compared with traditional open surgery? Professor Yan Yusheng introduced that TAVR via apical approach does not need cardiopulmonary bypass, does not need to open the sternum, has almost no obvious blood loss, shorter anesthesia time, less trauma and faster recovery. In addition, compared with TAVR via femoral artery approach, transapical approach has shorter delivery route, which can further reduce peripheral vascular complications.

in order to reduce the risk as much as possible, the team used 3D printing technology to restore the diseased valve and surrounding tissue, continuously optimized the operation plan and guided the precise implementation of the operation.

on August 2, Uncle Zhang’s operation was carried out as scheduled under the cooperation of many disciplines, such as cardiovascular surgery, cardiovascular medicine, anesthesia department, operating room, interventional therapy department, ultrasound imaging department, etc.

preoperative preparation, incision of the entrance, accurate positioning during the operation, placement of temporary pacemaker for rapid pacing, accurate release of heart valve, strict anesthesia management, maintaining stable circulation, and ready for rescue of heart failure and malignant arrhythmia at any time The operation lasted more than 40 minutes, with the tacit cooperation of various disciplines and teams, the whole operation was orderly and successful. When the valve was released and dilated, the cardiac function and related hemodynamic parameters of Uncle Zhang improved significantly.

two hours after the operation, Uncle Zhang regained consciousness, successfully pulled out the endotracheal tube and detached from the ventilator. Because of severe asthma before the operation, it was difficult for him to sleep safely. Finally, he could sleep peacefully until dawn. The results of postoperative examination showed that Zhang Shu’s cardiac function and other indicators were significantly improved, indicating that the problem of aortic stenosis was successfully solved. On August 8, after several days of postoperative recovery, Uncle Zhang was discharged from hospital and went home to recuperate.

Professor Yan Yusheng said that TAVR is a mature minimally invasive surgical method for the treatment of aortic stenosis, which is developed rapidly in recent years. It can significantly improve the quality of life with less pain and faster postoperative recovery. Especially for the elderly, weak constitution, poor preoperative cardiac function, unable to tolerate conventional cardiopulmonary bypass surgery, minimally invasive valve replacement is the best choice. (for more news, please pay attention to Yangcheng school