Subscribe to RSS
DOI: 10.1055/s-0029-1246969
Transcatheter valve replacement: anatomical evaluation of the „highway“ to the aortic valve
Objective: Transcatheter heart valve implantation can be performed transapically and transfemorally. The transfemoral way to the aortic valve is significant longer than the transapical one. The aim of this study was to describe the „Highway“ to the aortic valve with its technical pitfalls.
Material and methods: Fifteen human aortas have been analyzed (77±8.4years). These aortas were preserved with formalin and explanted from the iliac arteries to the ascending aorta. The diameters of the ascending aorta, the bracheocephalian trunk, the left subclavian artery, the descending aorta, and the iliac arteries were measured. The intima has been closely investigated by endoscopy. Furthermore a commercial available stent application system was used, and after that the intima was analyzed again.
Results: The measurements were shown in Table 1. The small diameter of the iliac arteries with 12±2.4mm will cause problems using a transfemoral approach. The endoscope showed significant intimal calcifications. After deplyment of the catheter the endoscopic investigation showed significant intimal damages in all parts of the aorta.
Conclusion: This study demonstrated that the passage of the „highway“ to the aortic valve can result in significant initmal damage.
|
asc. aorta |
arcus aortae |
desc. aorta |
bracheoceph. trunc |
subclav. art |
left iliaca |
right iliaca |
|
|
Ø (in mm) |
Ø (in mm) |
Ø (in mm) |
Ø (in mm) |
Ø (in mm) |
Ø (in mm) |
Ø (in mm) |
|
|
1 |
27.5 |
27 |
23.5 |
14.4 |
11.4 |
14.1 |
13,5 |
|
2 |
33,2 |
26.9 |
18.9 |
13.4 |
11.4 |
12,8 |
13,3 |
|
3 |
28,5 |
23,7 |
24.8 |
11,7 |
8,9 |
9,7 |
11,9 |
|
4 |
n.n. |
30 |
25 |
n.n. |
n.n. |
8,5 |
9 |
|
5 |
31.2 |
34.5 |
30.2 |
9.5 |
10 |
12 |
10 |
|
6 |
29,5 |
22 |
21.7 |
13,5 |
9,9 |
11 |
11 |
|
7 |
32,1 |
31,2 |
27.6 |
18 |
11,5 |
15,9 |
15,1 |
|
8 |
40 |
30,1 |
22.1 |
15 |
13,5 |
13.1 |
13.1 |
|
9 |
30.7 |
25.3 |
25.5 |
10.9 |
9.5 |
14.2 |
14.3 |
|
10 |
29,2 |
27.3 |
31.5 |
12 |
9 |
10.6 |
10.8 |
|
11 |
28,8 |
27.9 |
27 |
11.4 |
10 |
12,4 |
10,8 |
|
12 |
26,9 |
29.3 |
29.9 |
17.1 |
12.3 |
9.7 |
10.9 |
|
13 |
26,3 |
29.6 |
26.6 |
12.1 |
10.7 |
15.8 |
15.7 |
|
14 |
31 |
39 |
32 |
20 |
10 |
2.7 |
29 |
|
15 |
31 |
27 |
23.9 |
11 |
8 |
9 |
10 |
|
mean |
30.58 |
28.15 |
25,9 |
13.14 |
10.6 |
12.14 |
12.15 |
|
SD |
3.7 |
3.4 |
3.7 |
2.6 |
1.4 |
2.3 |
2.1 |