Off-pump transapical mitral valve-in-ring implantation.

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State: Public
Version: Final published version
Serval ID
serval:BIB_9E61932DED7A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Off-pump transapical mitral valve-in-ring implantation.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Zou Y., Ferrari E., von Segesser L.K.
ISSN
1873-734X (Electronic)
ISSN-L
1010-7940
Publication state
Published
Issued date
2013
Volume
43
Number
4
Pages
849-855
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish. PDF type: Original article
Abstract
OBJECTIVES: The study aimed to evaluate the feasibility of off-pump transapical mitral valve-in-ring implantation and to test the performance of a custom-made self-expandable stent valve, in comparison with the standard SAPIEN valve.
METHODS: Acute experiments were performed in five pigs. Animals (mean weight 58.4 ± 7.3 kg) underwent mitral valve annuloplasties under cardiopulmonary bypass using 26-mm rings (SJM?). Then, a 30-mm custom-made self-expandable stent valve or a 23-mm balloon-expandable transcatheter heart valve (Edwards SAPIEN XT?) was deployed within the annuloplasty rings through a transatrial access and under direct vision. Subsequently, the stent valves were inserted transapically under fluoroscopic guidance and off pump.
RESULTS: The procedural success of transatrial and transapical mitral valve-in-ring procedures was 100% (10 of 10). Mean transatrial and transapical procedure time was 2.0 ± 1.1 and 22.0 ± 5.7 min, respectively. Haemodynamic status during transapical implantation remained stable, and differences in data collected before and after the stent-valve deployment were not statistically significant. Mean mitral annulus diameter and mean mitral orifice area in the group of self-expandable stent valves were 2.60 ± 0.02 cm and 4.16 ± 0.48 cm(2), respectively, whereas in the SAPIEN group they were 1.95 ± 0.18 cm and 2.26 ± 0.20 cm(2), respectively. Trace or mild regurgitation was detected only in the self-expandable stent-valve group. Mean gradients were 4.1 ± 4.5 mmHg across the self-expandable stent valves and 1.0 ± 0 mmHg across the SAPIEN valves. Postmortem examination confirmed adequate positioning of the self-expandable valves and the SAPIEN valves within the annuloplasty ring.
CONCLUSIONS: Off-pump transapical mitral valve-in-ring implantation is safe and feasible. Transapical access may represent the ideal option for valve-in-ring procedures in cases of recurrent mitral regurgitation after mitral valve repair, in high-risk patients. Owing to the supra-annular profile of the valve components, our custom-made nitinol stent valve provides nearer to normal functional area than the SAPIEN valve.
Pubmed
Web of science
Open Access
Yes
Create date
25/04/2013 17:00
Last modification date
20/08/2019 15:04
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