Thorac Cardiovasc Surg 2009; 56 - P99
DOI: 10.1055/s-0029-1191663

Percutaneous aortic valve replacement: Transapical resection of the aortic valve in vivo

R Quaden 1, T Attmann 2, C Lesche 3, L Lozonschi 4, M Leester-Schädel 3, R Brinkmann 5, J Cremer 1, G Lutter 1
  • 1University Hospital of Schleswig-Holstein, Campus Kiel, Department of Cardiovascular Surgery, Kiel, Germany
  • 2University Hospital of Gießen, Divison of Cardiac Surgery, Gießen, Germany
  • 3University of Braunschweig, Institute for Microtechnology (IMT), Braunschweig, Germany
  • 4University of Wisconsin School of Medicine, Divison of Cardiothoracic Surgery, Madison, United States
  • 5University of Lübeck, Institute for Biomedical Optics, Lübeck, Germany

Aims: The feasibility of endoluminal resection of aortic valves has already been demonstrated in human preparation. The aim of this study was to analyze transapical laser-assisted resection of aortic valves in an in vivo porcine model.

Material and methods: Under direct vision, the resection was performed in a porcine model (n=10) using a thulium:YAG laser (wavelength 2.01µm, cw, 20 watts power rating). The transapical access was realized via a median sternotomy. After establishing a standard extracorporeal circulatory support, the aortic valve isolation chamber (AVIC) system was inserted transapically. It was approved as a sealed chamber in 9/10 cases. After admittance of cardioplegic solution, the resection of the aortic leaflets was carried out one-by-one in the arrested heart. The AVIC implantation, the resection process and the groß- and histological findings on the surrounding tissue were analyzed.

Results: The procedure to install the AVIC took 6.3±1.5min. The resection of the valves was performed in 8/10 and was completed in 7/10 cases. The procedure took on average 7.4±2.7min/cusp. In 9/10 cases, the sealing was sufficient, and in 1/10, no visualization was established. Gross and histological analysis demonstrated predominantly superficial damage to the surrounding tissue.

Conclusion: The feasibility of the in vivo on-pump-resection of the native aortic valve has been demonstrated. This approach brings the field closer to beating heart transapical aortic valve resection in humans.