Off-pump transapical mitral valve-in-ring implantation
Autor: | Yu Zou, Enrico Ferrari, Ludwig K. von Segesser |
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Rok vydání: | 2012 |
Předmět: |
Pulmonary and Respiratory Medicine
Cardiac Catheterization medicine.medical_specialty Mitral Valve Annuloplasty Swine medicine.medical_treatment Hemodynamics Regurgitation (circulation) law.invention law Internal medicine Mitral valve Cardiopulmonary bypass Animals Medicine cardiovascular diseases Heart valve Heart Valve Prosthesis Implantation Mitral valve repair Mitral regurgitation business.industry Mitral Valve Insufficiency Stent General Medicine Surgery medicine.anatomical_structure Heart Valve Prosthesis Cardiology Mitral Valve Female Stents Cardiology and Cardiovascular Medicine business |
Zdroj: | European Journal of Cardio-Thoracic Surgery. 43:849-855 |
ISSN: | 1873-734X 1010-7940 |
Popis: | 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. |
Databáze: | OpenAIRE |
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