Direct Access Valve Replacement (DAVR) — are we entering a new era in cardiac surgery?☆

Autor: Ludwig K. von Segesser, Christoph Huber
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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