title: Apico-Aortic Conduit for severe aortic stenosis: Technique, applications, and systematic review.
abstract: Patients referred for aortic valve replacement are often elderly and may have increased surgical risk associated with ascending aortic calcification, left ventricular dysfunction, presence of coronary artery disease, previous surgery, and/or presence of several co-morbidities. Some of these patients may not be considered candidates for conventional surgery because of their high risk profile. While transcatheter aortic valve replacement constitutes a widely accepted alternative, some patients may not be eligible for this modality due to anatomic factors. Apico-Aortic Conduit (AAC) insertion (aortic valve bypass surgery) constitutes a possible option in those patients. Apico-Aortic Conduit is not a new technique, as it has been used for decades in both pediatric and adult populations. However, there is a resurging interest in this technique due to the expanding scope of elderly patients being considered for the treatment of aortic stenosis. Herein, we describe our surgical technique and provide a systematic review of recent publications on AAC insertion, reporting that there is continued use and several modifications of this technique, such as performing it through a small thoracotomy without the use of the cardiopulmonary bypass.
authors: University of Ottawa Heart Institute, Division of Cardiac Surgery, 40 Ruskin Street, Suite 3403, Ottawa, Canada ON K1Y 4W7.
authors: Elsayed
authors: E
authors: Elmistekawy
authors: Harry
authors: H
authors: Lapierre
authors: Thierry
authors: T
authors: Mesana
authors: Marc
authors: M
authors: Ruel
keywords: AAC, Apico Aortic Conduit; AS, aortic stenosis; AVR, aortic valve replacement; Aortic stenosis; Aortic valve bypass surgery; Aortic valve replacement; Apico-Aortic Conduit; BSA, body surface area; CABG, coronary artery bypass grafting surgery; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CPB, cardiopulmonary bypass; DHCA, deep hypothermic circulatory arrest; FEM-FEM, femoro-femoral; ITA, internal thoracic artery; LITA, left internal thoracic artery; LVH, left ventricular hypertrophy; LVOT, left ventricle outflow tract; MDCT, multidetector-computerized tomography; MVR, mitral valve replacement; NYHA, New York Heart Association; OPCAB, off pump coronary artery bypass; PH, pulmonary hypertension; RITA, right internal thoracic artery; TAVI, transcatheter aortic valve implantation; TEE, transesophageal echocardiography
references: Eur J Cardiothorac Surg. 2007 Jan;31(1):126
references: 17127073
references: J Thorac Cardiovasc Surg. 2009 Mar;137(3):680-7
references: 19258088
references: Ann Surg. 1910 Jul;52(1):83-95
references: 17862563
references: Interact Cardiovasc Thorac Surg. 2006 Jun;5(3):227-33
references: 17670552
references: Circulation. 2008 Sep 30;118(14):1460-6
references: 18794389
references: Circulation. 1982 Nov;66(5):1105-10
references: 7127696
references: Tex Heart Inst J. 2000;27(1):24-8
references: 10830624
references: J Thorac Cardiovasc Surg. 2006 Oct;132(4):796-801
references: 17000290
references: Kardiol Pol. 2009 Jul;67(7):765-8
references: 19649999
references: Interact Cardiovasc Thorac Surg. 2009 Aug;9(2):377-8
references: 19443492
references: Interact Cardiovasc Thorac Surg. 2007 Jun;6(3):374-5
references: 17669869
references: J Am Coll Cardiol. 2001 Mar 1;37(3):885-92
references: 11693766
references: Ann Thorac Surg. 2010 Feb;89(2):621-3
references: 20103361
references: Ann Thorac Surg. 2009 Mar;87(3):927-8
references: 19231422
references: Rev Esp Cardiol. 2009 Oct;62(10):1194-5
references: 19793528
references: Circulation. 2008 Apr 1;117(13):1750-67
references: 18332270
references: Kyobu Geka. 2003 Dec;56(13):1139-43
references: 14672027
references: Kyobu Geka. 2006 Apr;59(4):294-300
references: 16613147
references: J Heart Valve Dis. 2004 Jan;13(1):57-62; discussion 62-3
references: 14765841
references: Ann Thorac Surg. 2004 Jul;78(1):85-9
references: 15223409
references: Circulation. 1955 Apr;11(4):564-75
references: 14364731
references: J Thorac Cardiovasc Surg. 2004 Jan;127(1):270-2
references: 14752443
references: Circulation. 1994 Feb;89(2):642-50
references: 8313553
references: Ann Thorac Surg. 2006 Dec;82(6):2111-5
references: 17126120
references: Ann Thorac Surg. 2009 Sep;88(3):998-1000
references: 19699941
references: Am J Cardiol. 1980 Jun;45(6):1265-71
references: 7377124
references: Ann Thorac Surg. 2000 May;69(5):1511-4
references: 10881832
references: J Thorac Cardiovasc Surg. 2006 Jul;132(1):155-6
references: 16798319
references: Circulation. 2006 Mar 7;113(9):e388-9
references: 16520418
references: Curr Opin Cardiol. 2010 Mar;25(2):107-13
references: 20090520
references: South Med J. 1989 Jun;82(6):756-7
references: 2734637
references: J Thorac Cardiovasc Surg. 1984 Jul;88(1):82-91
references: 6738105
references: Anesth Analg. 2010 Mar 1;110(3):728-30; discussion 730
references: 20056958
references: Ann Thorac Surg. 1981 Oct;32(4):369-76
references: 6458251
references: Int J Cardiovasc Imaging. 2007 Apr;23(2):281-5
references: 16855856
references: Eur Heart J. 1987 May;8(5):471-83
references: 3609042
references: Ann Thorac Surg. 2006 May;81(5):1605-10
references: 16631642
references: Cardiovasc Dis. 1975;2(4):376-383
references: 15216010
references: Asian Cardiovasc Thorac Ann. 2006 Aug;14(4):e76-9
references: 16868094
references: Gerontology. 2003 Jan-Feb;49(1):46-9
references: 12457050
references: J Card Surg. 2003 Sep-Oct;18(5):396-401; discussion 402-3
references: 12974924
references: Herz. 2002 Dec;27(8):795-8
references: 12574899
references: Gen Thorac Cardiovasc Surg. 2009 Sep;57(9):467-70; discussion 470-1
references: 19756933
references: Circulation. 2007 Jul 24;116(4):e88-9
references: 17646589
references: Interact Cardiovasc Thorac Surg. 2009 Oct;9(4):703-5
references: 19584069
references: Circulation. 2002 Dec 10;106(24):3006-8
references: 12473543
references: Eur J Cardiothorac Surg. 2003 Feb;23(2):156-8
references: 12559335
references: Lancet. 2000 Oct 21;356(9239):1403-5
references: 11052583
references: Lancet. 1986 Jan 11;1(8472):63-7
references: 2867315
references: Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):486-8
references: 20007638
references: J Interv Cardiol. 2006 Jun;19(3):269-75
references: 16724971