AVBG in the News

James S. Gammie, M.D., Associate Professor of Surgery, Maryland Heart Center

James S. Gammie, M.D., Associate Professor of Surgery, Maryland Heart Center

Dr. James Gammie, a cardiac surgeon at the University of Maryland, has performed many AVBG (Aortic Valve Bypass Graft) procedures over the past few years.

Recently, Shelly Wood, a reporter for heartwire, did a story on his work in this area.  The article is titled Aortic-valve bypass: A time-tested, minimally invasive alternative to valve-replacement surgery.   I think Ms. Wood did an excellent job explaining the procedure and Dr. Gammie’s clinical experience.  Below is an excerpt from her article.

But Gammie believes that AV-bypass surgery would likely compete directly with transcatheter aortic-valve replacement and indeed has several advantages.

For one, a wide range of valve prosthetics can be used in the apicoaortic conduit-those used in Gammie et al’s study have a long track record of safety and durability, he notes. Likewise, the procedure itself, while not widely used, has proven its durability. “There are people walking around today who had this operation a quarter century ago,” Gammie points out. “So we know it’s a durable approach.”

Third, there is no disruption to the native valve and no permanent prosthetic forced over the calcified valve leaflets, thus reducing the risk of both perioperative and long-term stroke. There’s also no risk of heart block-a side effect seen following the implantation of permanent percutaneously placed devices, Gammie notes. Finally, perivalvular leak is not a potential problem, since the device does not need to be sized within the native valve. “So patient-prosthetic mismatch is not a problem,” he said.

On a more hypothetical note, Gammie said that he and his colleagues are testing whether diverting blood flow away from the calcified native valve would in itself decrease stroke rates over the long term. Preliminary analysis suggests that roughly two-thirds of the blood volume may be diverted through the conduit, a rerouting that may prove beneficial over time. “Our hypothesis, which we haven’t proven yet, is that AV bypass surgery may be ‘brain-protective,’ because of the blood flow configuration in the long term,” he speculated.

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