2020, Number 2
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Cir Card Mex 2020; 5 (2)
The Zero-Tolerance Approach to Standard AVR
Antunes MJ
Language: English
References: 14
Page: 34-37
PDF size: 217.12 Kb.
ABSTRACT
Conventionally, aortic valve stenosis (AS) is treated by
surgical replacement of the valve (AVR), a very standardized
and usually simple procedure that, however, still
carries a significant perioperative mortality and morbidity,
besides being associated to the late complications of
the prostheses used. This procedure has been challenged
by the recent introduction of percutaneous aortic valve
implantation (TAVI), allegedly with better periprocedural
results and, at least, similar longterm outcomes. Indeed,
some believe that it will result in the demise of the
surgical procedure.
In this text, I intend to demonstrate that we can obtain
much better results with AVR than our cardiologists and
ourselves believe. Using the Six-sigma (6-σ) developed
by the industry that assures that 99.99966% of the products
manufactured are statistically expected to be free
of defects (3.4 defective parts/million). I believe that this
concept is applicable to surgery. Indeed, some reference
surgical centers now routinely have perioperative mortalities
for AVR lower than 1%. Several risk factors for
death and other complications have been identified that
can be modified pre-operatively, leading to lower mortality
and morbidity rates. Also, technical aspects of the
procedure can be adjusted or modified with the same
goal. Finally, the Heart Team and of the surgical staff,
medical and nursing, play an important role in the success
of the surgery, which, in my view, will still be part of
our surgical armamentarium for the foreseeable future.
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