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Prof R Gaeta Chirurgia Cardiaca (SSD Med 23)

Università degli Studi di Messina UOC di Cardiochirurgia Azienda Ospedaliera Universitaria Policlinico “G. Martino” dir. Prof. Roberto Gaeta. PROTESI VALVOLARI CARDIACHE - corso integrato malattie apparato cardiovascolare e respiratorio -. Prof R Gaeta Chirurgia Cardiaca (SSD Med 23).

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Prof R Gaeta Chirurgia Cardiaca (SSD Med 23)

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  1. Università degli Studi di MessinaUOC di CardiochirurgiaAzienda Ospedaliera Universitaria Policlinico “G. Martino”dir. Prof. Roberto Gaeta PROTESI VALVOLARI CARDIACHE - corso integrato malattie apparato cardiovascolare e respiratorio - Prof R Gaeta Chirurgia Cardiaca (SSD Med 23)

  2. PROTESI VALVOLARI CARDIACHE • ARTIFICIALI • BIOPROTESI PALLA DISCO BIDISCO AUTOLOGHE OMOLOGHE ETEROLOGHE

  3. PROTESI VALVOLARI CARDIACHE ARTIFICIALI STARR-EDWARDS MAGOVERN SMELOFF-CUTTER PALLA

  4. Braunwald Polyurethane mitral valve. First mitral valve replacement on March 11, 1960. Teflon chordae brought through the ventricular muscle and secured outside the heart Kay Mitral Valve. Teflon mitral valve prosthesis with artificial chordae. Implanted 1959 Original Starr-Edwards Mitral Valve. Lucite cage. Silastic rubber ball occluder. Implanted 1960. Harken double cage ball valve. Implanted in 1960

  5. Albert Starr, MD, Ph D

  6. STARR - EDWARDS

  7. STARR EDWARDS

  8. MAGOVERN

  9. SMELOFF-CUTTER

  10. PROTESI VALVOLARI CARDIACHE ARTIFICIALI BEALL BJORK SHILEY SORIN MEDTRONIC HALL LILLEHEI KASTER MONODISCO

  11. BEALL

  12. BJORK-SHILEY

  13. BJORK-SHILEY

  14. SORIN

  15. MEDTRONIC HALL

  16. LILLEHEI KASTER

  17. PROTESI VALVOLARI CARDIACHE ARTIFICIALI ST. JUDE CARBOMEDICS DUROMEDICS SORIN BIDISCO

  18. ST. JUDE

  19. ST. JUDE

  20. CARBOMEDICS

  21. SORIN

  22. Flow characteristics • ball/cage < tilting dic < bileaflet • Thrombogenic potential • ball/cage > tilting disc > bileaflet • Aortic < Mitral < both

  23. PROTESI VALVOLARI CARDIACHE • ARTIFICIALI • BIOPROTESI PALLA DISCO BIDISCO AUTOLOGHE OMOLOGHE ETEROLOGHE

  24. PROTESI VALVOLARI CARDIACHE BIOPROTESI PERICARDICHE FASCIA LATA V. POLMONARE (Intervento di ROSS) AUTOLOGHE

  25. PROTESI VALVOLARI CARDIACHE • STENTED • PORCINE • PERICARDICHE • STENTLESS • PORCINE • BOVINE • PERICARDICHE BIOPROTESI AUOTGRAFT OMOGRAFT

  26. Pulmonary Autograft (Ross Procedure- 1967) • Advantages • Viable tissue, excellent hemodynamics • Near 0% thromboembolism, growth potential • Non-antigenic • Pulmonary valve equal in strength as aortic valve • Disadvantage • Creating 2-way valve pathology from single valve disease • Results • Freedom from re-operation 81% at 8 years • 5-10% annular dilatation and regurgitation • Pulmonary homograft deterioration • Technique • Root replacement preferred • Tailoring of aortic/pulmonary size mismatch • Bolstering ring with Dacron strip • Long-term follow-up still accruing

  27. The Ross Operation

  28. PROTESI VALVOLARI CARDIACHE BIOPROTESI OMOLOGHE HOMOGRAFT (cadavere)

  29. HOMOGRAFT

  30. AORTIC HOMOGRAFT

  31. Homograft implantation: the “root” technique

  32. MITRAL Homograft

  33. PROTESI VALVOLARI CARDIACHE BIOPROTESI BOVINE C-E HANCOCK MITROFLOW XENOGRAFT

  34. C-E

  35. C-E

  36. C-E

  37. C-E

  38. HANCOCK

  39. HANCOCK

  40. MITROFLOW

  41. MITROFLOW

  42. PROTESI VALVOLARI CARDIACHE ARTIFICIALI • ANTICOAGULAZIONE • LUNGA DURATA • RUMORE

  43. Anticoagulation Management (Machanical Prosthesis) • TIA is most common event • Standardization of coagulation management (INR) • Narrow therapeutic range: balance between thrombolic and bleeding risk • ACCP recommendations: INR 2.5-3.5 • Aortic: 2.5-3.0 • Mitral: 3.0-3.5 • Both: 3.5-4.0 • Appropriate use of antiplatelet therapy

  44. PROTESI VALVOLARI CARDIACHE BIOLOGICHE • NO ANTICOAGULAZIONE • DURATA MEDIA (10-12 anni) • SILENZIOSE

  45. PROTESI VALVOLARI CARDIACHE • TROMBOEMBOLIA • INFEZIONI • LEAK

  46. The Perfect Valve • Excellent hemodynamics • Non-thrombogenic • Durable • Unrestricted availability • Easily implantable • Silent function • Low cost

  47. Valvulopatia Mitralica

  48. Anatomy and Pathology 1. Crucial to understand the anatomy of the mitral valve in order or perform valve repair/surgery 2. Mitral valve is composed of five separate components: a. valvular leaflets b. annulus c. chordae tendinae d. papillary muscles e. left ventricular wall

  49. Pathology • Rheumatic Disease • Myxomatous Degeneration • Ischemic Valvulopaty • Endocarditis

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