Direct access valve replacement (DAVR) - are we entering a new era in cardiac surgery?

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Serval ID
serval:BIB_11D62C09E3F4
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Direct access valve replacement (DAVR) - are we entering a new era in cardiac surgery?
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
Huber C.H., von Segesser L.K.
ISSN
1010-7940
Publication state
Published
Issued date
03/2006
Peer-reviewed
Oui
Volume
29
Number
3
Pages
380-385
Language
english
Notes
Publication types: Evaluation Studies ; Journal Article. - Old month value: Mar
Abstract
OBJECTIVE: This study validates the off-pump antegrade trans-ventricular route for ultrasound-guided direct access aortic valve replacement. Direct access aortic valve replacement using a transthoracic and valved stent-based approach offers numerous advantages over the remote access percutaneous approach and may one day provide an alternative treatment modality for aortic valve disease. METHODS: Valved stents were implanted off-pump in 17 pigs (72.10+/-8.4 kg) via the direct access transapical approach using a left-sided mini-thoracotomy and continuous ultrasonic and fluoroscopic guidance. Acute valved stent function was studied with intravascular and two-dimensional intracardiac ultrasound. The invasive valve gradient was assessed with pull-back pressure catheter. All valved stents were tested in vitro before insertion. Macroscopic analysis was performed at necropsy. RESULTS: In 11 of the 17 pigs, valved stents were delivered to the target site over the native aortic valve leaflets without interference of coronary blood flow and with good acute valve function. Three valved stents were deployed supra-annularly, two of those occluded the right coronary orifice and one the left coronary orifice, leading to fatal outcomes. Three valved stents dislodged into the left ventricle, one because of size-mismatch and two because of failure to unfold correctly. In 11 properly sized and deployed valved stents, two showed a moderate and one a severe paravalvular leak. CONCLUSIONS: Seventeen pigs underwent direct access valve replacement of the aortic valve with deployment of a valved stent into the native aorta. Eleven valves observed for an average 5-h period showed satisfactory, postimplantation valve function.
Keywords
Animals, Aortic Valve/surgery, Aortic Valve/ultrasonography, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation/instrumentation, Heart Valve Prosthesis Implantation/methods, Intraoperative Care/methods, Prosthesis Design, Stents, Surgical Procedures, Minimally Invasive/instrumentation, Surgical Procedures, Minimally Invasive/methods, Swine, Ultrasonography, Interventional/methods
Pubmed
Web of science
Open Access
Yes
Create date
29/01/2008 14:44
Last modification date
25/09/2019 6:08
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