Percutaneous aortic valve replacement: resection before implantation☆

Quaden, René; Attmann, Tim; Boening, Andreas; Cremer, Jochen; Lutter, Georg

doi:10.1016/j.ejcts.2005.01.048

Cited by 50 publications

(33 citation statements)

References 8 publications

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“…The model developed in this study can easily be modified in order to generate a bicuspid valve, by a fusion of two leaflets for example, or can be combined to an experimental model of coronary flow to evaluate the impact of TAV on coronary circulation. Also, a device aiming at percutaneous aortic valve resection prior to TAVI can be tested on the model developed in this work [17]. Furthermore, the model can be useful for training, in vitro, surgeons on good positioning of TAV during implantation.…”

Section: Discussionmentioning

confidence: 99%

An In Vitro Model of Aortic Stenosis for the Assessment of Transcatheter Aortic Valve Implantation

Maleki

Shahriari

Labrosse

et al. 2014

Journal of Biomechanical Engineering

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A significant number of elderly patients with severe symptomatic aortic stenosis are denied surgical aortic valve replacement (SAVR) because of high operative risk. Transcatheter aortic valve implantation (TAVI) has emerged as a valid alternative to SAVR in these patients. One of the main characteristics of TAVI, when compared to SAVR, is that the diseased native aortic valve remains in place. For hemodynamic testing of new percutaneous valves and clinical training, one should rely on animal models. However, the development of an appropriate animal model of severe aortic stenosis is not straightforward. This work aims at developing and testing an elastic model of the ascending aorta including a severe aortic stenosis. The physical model was built based on a previous silicone model and tested experimentally in this study. Experimental results showed that the error between the computer-aided design (CAD) file and the physical elastic model was <5%, the compliance of the ascending aorta was 1.15 ml/mm Hg, the effective orifice area (EOA) of the stenotic valve was 0.86 cm 2 , the peak jet velocity was 4.9 m/s and mean transvalvular pressure gradient was 50 mm Hg, consistent with as severe. An EDWARDS-SAPIEN 26 mm valve was then implanted in the model leading to a significant increase in EOA (2.22 cm 2 ) and a significant decrease in both peak jet velocity (1.29 m/s) and mean transvalvular pressure gradient (3.1 mm Hg). This model can be useful for preliminary in vitro testing of percutaneous valves before more extensive animal and in vivo tests.

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Section: Discussionmentioning

confidence: 99%

An In Vitro Model of Aortic Stenosis for the Assessment of Transcatheter Aortic Valve Implantation

Maleki

Shahriari

Labrosse

et al. 2014

Journal of Biomechanical Engineering

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“…In contrast to our concept, Quaden et al reported on valve resection times of 2.3 AE 0.3 min up to 12.2 AE 0.8 min (per leaflet) with the use of a high-pressure water stream scalpel [15]. Recently, resection times of 6.0 AE 3.5 min per leaflet using a YAG laser device were reported [16].…”

Section: Discussionmentioning

confidence: 87%

“…Therefore, transcatheter valve implantation has become a more widely available and accepted therapeutic procedure [17]. However, the idea to resect the diseased native aortic valve prior to the percutaneous aortic valve implantation procedure has been suggested by Quaden et al [15] in 2005, and to our knowledge, is so far the only study group working on this issue. Due to the fact that in transcatheter techniques, the pathology of the severely calcified aortic valve remains in situ and the aortic bioprosthesis has to be implanted in a severely calcified and rather asymmetric annulus, paravalvular leakages can be observed more frequently [18,19].…”

Section: Discussionmentioning

confidence: 93%

“…Therefore, the endovascular resection of the degenerated native heart valve would be advantageous prior to a catheter-based implantation [15,16]. For this purpose the West German Heart Center Essen in collaboration with Endosmart W GmbH and the Department of Physical Engineering, Fachhochschule Gelsenkirchen, developed an innovative prototype of a novel heart valve resection tool based on foldable nickel-titanium (NiTi) blades (European and US patent pending).…”

Section: Introductionmentioning

confidence: 99%

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In vitro results of a new minimally invasive aortic valve resecting tool☆☆☆

Wendt

Müller

Hauck³

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Background: Aortic valve replacement (AVR) using extracorporeal circulation is currently the treatment of choice for symptomatic aortic stenosis. However, patients with multiple high-risk comorbid conditions may benefit from reduced ECC time by a simplified and faster resection in conjunction with quick sutureless valve implantation. Methods: A prototype of a new minimally invasive aortic valve resection tool equipped with rotating and foldable Nitinol cutting edges was designed. Commercially available aortic valve bioprostheses were artificially calcified (group 1: moderate calcified, n = 8, group 2: severely calcified, n = 8). In vitro resection was performed using a 21 mm cutting blade. Resection time (RT), maximum turning moment (MTM) and number of required rotations (NR) were measured. Furthermore, particle generation during the process of cutting was obtained and quantified. Results: Aortic valve cutting could be obtained without any complications in all cases. Cutting process resulted in a RTof 15.5 AE 3 s in group 1 compared to 34.9 AE 15 s in group 2 ( p = 0.005), MTM was 3 AE 0.6 N m in group 1 compared to 3.5 AE 0.6 N m in group 2 ( p = 0.068) and NR were 30.6 AE 2.3 in group 1 compared to 48.1 AE 15.5 in group 2 ( p = 0.007). Particle generation was 1.77 AE 0.17 g in group 1 compared to 1.41 AE 0.44 g in group 2 ( p = 0.047). Conclusions: These first in vitro results confirm feasibility and accelerated aortic valve resection within 30 s. This new concept holds promise for very fast AVR in combination with insertion of sutureless aortic valve prosthesis, targeting for ischemic times less than 10 min in the open heart situation. Finally, resection and percutaneous AVR within 1 min in the beating heart situation is envisioned. #

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“…This strategy would be close to the 'gold standard' represented by the conventional prosthetic valve replacement that has been performed routinely for the past four decades. Strategies for the transapical resection of native aortic valve tissue have been examined and reported [58][59][60][61]. For example, a sophisticated method of in-situ transluminal resection of aortic valve leaflets using a YAG laser within an aortic valve isolation chamber has been developed.…”

Section: Experimental Transapical Implantation Of the Perceval S Valvementioning

confidence: 99%

Recent developments for surgical aortic valve replacement: The concept of sutureless valve technology

Carrel¹,

Englberger²,

Stalder³

2013

Open J Cardiol

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Percutaneous aortic valve replacement: resection before implantation☆

Cited by 50 publications

References 8 publications

An In Vitro Model of Aortic Stenosis for the Assessment of Transcatheter Aortic Valve Implantation

An In Vitro Model of Aortic Stenosis for the Assessment of Transcatheter Aortic Valve Implantation

In vitro results of a new minimally invasive aortic valve resecting tool☆☆☆

Recent developments for surgical aortic valve replacement: The concept of sutureless valve technology

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