Direct Access Valve Replacement (DAVR) — are we entering a new era in cardiac surgery?☆
Autor: | Ludwig K. von Segesser, Christoph Huber |
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Rok vydání: | 2006 |
Předmět: |
Pulmonary and Respiratory Medicine
Aortic valve medicine.medical_specialty Swine medicine.medical_treatment Prosthesis Design Aortic valve replacement Valve replacement Internal medicine medicine.artery medicine Animals Minimally Invasive Surgical Procedures cardiovascular diseases Ultrasonography Interventional Heart Valve Prosthesis Implantation Aorta Intraoperative Care business.industry Aortic Valve/surgery Aortic Valve/ultrasonography Heart Valve Prosthesis Heart Valve Prosthesis Implantation/instrumentation Heart Valve Prosthesis Implantation/methods Intraoperative Care/methods Stents Surgical Procedures Minimally Invasive/instrumentation Surgical Procedures Minimally Invasive/methods Ultrasonography Interventional/methods Stent General Medicine medicine.disease Surgery Cardiac surgery Catheter medicine.anatomical_structure Ventricle Aortic Valve Cardiology Cardiology and Cardiovascular Medicine business |
Zdroj: | European Journal of Cardio-Thoracic Surgery, vol. 29, no. 3, pp. 380-385 |
ISSN: | 1010-7940 |
Popis: | 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 ofthoseoccludedtherightcoronaryorificeandonetheleftcoronaryorifice,leadingtofataloutcomes.Threevalvedstentsdislodgedintotheleft 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. # 2005 Elsevier B.V. All rights reserved. |
Databáze: | OpenAIRE |
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