Double-crowned valved stents for off-pump mitral valve replacement

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Serval ID
serval:BIB_EFCFBB7BB741
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Double-crowned valved stents for off-pump mitral valve replacement
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
Ma  L., Tozzi  P., Huber  C. H., Taub  S., Gerelle  G., von Segesser  L. K.
ISSN
1010-7940
Publication state
Published
Issued date
08/2005
Peer-reviewed
Oui
Volume
28
Number
2
Pages
194-8; discussion 198-9
Notes
Journal Article --- Old month value: Aug
Abstract
OBJECTIVE: An animal model has been designed to assess the feasibility of off-pump mitral valve replacement using valved stents. METHODS: Glutaraldehyde-preserved homograft was sutured inside a prosthetic tube (Dacron). Then, two self-expandable nitinol Z-stents were sutured on the external surface of the prosthesis in such a way to create two self-expanding crowns for fixation. In adult pigs and under general anesthesia, the left atrium was exposed through a left thoracotomy and atrio-ventricular roadmapping was performed with intravascular ultrasound (IVUS) and fluoroscopy. The double-crowned valved stents were loaded into a delivery sheath. The sheath was then introduced into the left atrium and the valved stents was deployed in mitral position in such a way that the part in between the two stents was at the level of the mitral annulus. Intracardiac Unltrasound (ICUS) was used to assess the valve function. Hemodynamic parameters were gathered as well. Animal survived for no more than 3h after the valve deployment and gross anatomy examination of the left heart was carried out. RESULTS: The mean height of the valved stents was 29.4+/-0.2 mm, with an internal diameter of 20.4+/-1.0mm, and an external diameter of 25.5+/-0.8 mm. The procedure was successfully carried out in eight animals. In vivo evaluation showed a native mitral annulus diameter of 24.9+/-0.6 mm, and a mean mitral valve area of 421.4+/-17.5 mm2. ICUS showed a mild mitral regurgitation in three out of eight animals. Mean pressure gradient across the valved stents was 2.6+/-3.1 mmHg. Mean pressure gradient across the left ventricular outflow tract (LVOT) was 6.6+/-5.2 mmHg. The mean survival time was 97.5+/-56.3 min (survival time range was 40-180 min). One animal died due to the occlusion of the LVOT because of valved stents displacement. Postmortem evaluation confirmed correct positioning of the valved stent in the mitral position in seven out of eight animals. No atrial or ventricular lesions due to the valved stents were found. CONCLUSIONS: Off-pump implantation of a self-expandable valved stent in the mitral position is technically feasible. Further studies will assess if this procedure is also feasible in humans.
Keywords
Animals Aortic Valve Insufficiency/physiopathology/*surgery/ultrasonography Coronary Artery Bypass, Off-Pump/methods Disease Models, Animal Echocardiography Equipment Design Feasibility Studies Heart Valve Prosthesis Implantation/adverse effects/*methods Mitral Valve/*surgery/ultrasonography *Stents Swine Ventricular Dysfunction, Left/etiology
Pubmed
Web of science
Open Access
Yes
Create date
29/01/2008 15:45
Last modification date
01/10/2019 7:20
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