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Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

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.


REFERENCES

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