Rainer G. H. Moosdorf
University Hospital of Giessen and Marburg GmbH, Germany
Keynote: J Clin Exp Cardiolog
In an elderly population, many patients are suffering from multiple cardiovascular problems at different locations. Age and multimorbidity are limits for conventional open heart surgery. New hybrid interventions are offering tailored treatment options also for this growing group of patients: Patients with cerebrovascular disease and status post stroke are frequently also suffering from degenerative aortic valve disease. One such tailored hybrid procedure consists of a typical endarterectomy of the affected carotid artery, mostly under local anesthesia, followed by a catheter-based aortic valve replacement via a vascular graft anastomosed to the patients common carotid artery, which contains the necessary ports for the TAVI (transcatheter aortic valve implantation) and avoids major interferences with carotid flow. We have performed this procedure in 4 patients, among them one with a bilateral endarterectomy. All of them were discharged home without new neurologic pathologies. This procedure will be demonstrated in detail. Many elderly patients are referred to us for a TAVI procedure but preoperative investigations reveal further significant cardiac pathologies such as coronary artery disease with severe left main or diffuse triple vessel involvement, further valvular disease or even congenital defects. In a novel hybrid approach, we address the other pathologies in the typical open fashion and finally insert a TAVI valve under direct vision via a small mini aortotomy. So the aortic valve replacement does add no more than 10 minutes to the cross clamp time and such, even complex operations may be performed in very old and multimorbid patients with a reasonable risk, as demonstrated in already more than 20 patients. With new tailored hybrid approaches, individual complex cardiovascular pathologies in elderly and multimorbid patients can be treated with an acceptable risk and good results..
Rainer Moosdorf is working in field of Cardiovascular Surgery since more than 35 years. He started his career as Resident at University Hospital in Giessen in 1978. In 1990, he became a full Professor for Cardiovascular Surgery at University in Bonn and Vice Chairman of the respective department. In 1989 and 1990, he was a Researcher & Clinical Fellow at Carolinas Heart Institute in Charlotte/NC. Since 1994, he has been working at University Hospital in Marburg as a full Professor for Cardiovascular Surgery & Director of the Department. Between 2001 & 2011, he was Vice Medical Director and since 2006, Medical Director at University Hospital in Marburg. His main specialties within cardiovascular surgery are “Laser and arrhythmia surgery, endovascular procedures including TAVI´s and endovascular reconstructions of the aortic arch, reconstructive surgery of the coronaries and some types of the French correction”. As Chairman of the board of Medical Network Hessen, he is an official representative of the State of Hessen in the field of Clinical Medicine & MedicalEducation.