Tanscatheter Cerebral Embolic Filters in Cardiac Surgery: A Hybrid Solution to Minimize Postoperative Stroke
Postoperative stroke after cardiac surgery is a rare but catastrophic complication. Most commonly, it results from embolic dislodgement of atherosclerotic debris that may occur during surgical manipulation of the ascending aorta. Thus, as a strong risk factor for postoperative stroke (1), heavy calcifications of the ascending aorta often contraindicate surgery and shift therapy to less appropriate forms of treatment, medical or percutaneous.
At the Lancisi Cardiovascular Center, the recent surgeons’ acquisition of transcatheter skills has made possible the realization of new hybrid interventions that allow, in some particular patients, to expand the current options of treatment with improved results.
With this video, the authors would like to share how they are combining catheter-based and open surgical therapies in patients with heavily calcified ascending aorta to decrease their postoperative risk of stroke in Ancona, Italy (2).
The patient was a 78-year-old man who was referred to the authors’ hospital for a severe mitral regurgitation associated with a moderate tricuspid regurgitation and a large atrial septal defect. Preoperative CT scan revealed heavy calcifications at the ascending aorta which configured a high risk of postoperative gross neurological complications. The patient was successfully treated combining the use of a catheter-based cerebral protection system with a minimally invasive transaxillary multiple valve repair.
The authors believe this case represents an emblematic example of how transferring catheter-based techniques and technologies into open surgical procedures may be beneficial to patients and give attention within the specialty.
- den Harder AM, de Heer LM, Meijer RC, Das M, Krestin GP, Maessen JG, et al. Effect of computed tomography before cardiac surgery on surgical strategy, mortality and stroke. Eur J Radiol. 2016 Apr;85(4):744-50.
- Di Eusanio M, Cefarelli M, Berretta P, Capestro F. Minimally invasive aortic valve replacement with a catheter-based cerebral protection system: transferring percutaneous technologies into a surgical intervention. Eur J Cardiothorac Surg. 2019 Nov 1;56(5):1016-1017.