Endoscopic access closure for direct implantation of valved stents

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Version: Final published version
Serval ID
serval:BIB_424D8FDDB643
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Endoscopic access closure for direct implantation of valved stents
Journal
Swiss Medical Weekly
Author(s)
Tozzi P., Pawelec-Wojtalic M., Bukowska D., Ferrari E., Siniscalchi G., von Segesser L. K.
ISSN
1424-7860 (Print)
Publication state
Published
Issued date
03/2007
Volume
137
Number
11-12
Pages
182-4
Language
english
Notes
Journal Article --- Old month value: Mar 24
Abstract
OBJECTIVES: The off-pump trans left ventricular approach provides an alternative option for insertion of stented aortic valves of any size for endovascular replacement. One of the key steps in this procedure is the repair of the ventricle after catheter withdrawal. This study evaluates the reliability of a new device for sutureless and quick repair of the left ventricle access. METHODS: The Amplatz-nitinol occluder consists of two square heads that squeeze the ventricle wall between them thus sealing the ventricular defect. In four adult pigs weighing 55 kg, left thoracoscopy was performed to open the pericardium and visualise the cardiac apex. Following a heparin injection (100 U/kg) under ICUS and fluoroscopic control, we inserted a 30 F sheath into the epigastric area through the cardiac apex up into the left ventricle thus simulating the approach for an off-pump aortic valve replacement. The sheath was then removed and the ventricle closed with the occluder. Animals were followed-up for three hours; the haemodynamics and pericardial bleeding were recorded. The animals were then sacrificed and the gross anatomy of the heart was examined. RESULTS: The device was successfully deployed in four animals in less than one minute. ACT was above 200 seconds in all cases. All animals survived the procedure with a mean arterial pressure of 50 +/- 15 mm Hg. Bleeding during deployment was 80 +/- 20 ml and over a 3 hour period was 800 +/- 20 ml. Examination of the gross anatomy examination demonstrated the correct positioning of the device. CONCLUSIONS: The occluder is easy to use and the procedure is feasible and reproducible. However, the occluder design requires technical improvements in order to reduce bleeding before it can be used clinically.
Keywords
Animals Aortic Valve/*surgery Cardiac Surgical Procedures/*methods Endoscopy/*methods Heart Ventricles/*surgery Humans *Stents Swine
Pubmed
Web of science
Create date
28/01/2008 9:16
Last modification date
20/08/2019 13:44
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