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DOI: 10.1055/s-0030-1269152
Development of a large animal model for hybrid pulmonary valve implantation
Introduction: Interventional implantation of pulmonary valves (PV) via peripheral vascular access is often limited by tortuous pathways or size restraints of the PV. In these cases hybrid procedures may be an alternative.
Methods: We tested the feasibility of hybrid PV implantation in an acute pig model (n=12) using self-made stent-mounted valves. We used both expandable bare metal stents (n=10) and self-expanding nitinol stents (n=2). Heart valves consisted of bovine jugular veins (n=3), bovine pericardial valves (n=4), or sprayed polyurethane valves (n=5). Access was achieved via partial lower (n=5), median (n=5), or transverse sternotomy (n=1), or right anterior thoracotomy (n=1) or. A large sheet was introduced through Teflon-armed U-sutures directly into the RV. The stented PV was placed under fluoroscopic and epicardial echocardiographic guidance.
Results: We were able to demonstrate the feasibility of the procedure in an acute pig model. No limitations regarding the size of the stented valve were seen. In a non-calcified PV the stent has to be substantially oversized (at least twice the PV diameter). The best trade-off between feasibility and minimized trauma for long-term animal trials was the lower partial sternotomy.
Conclusions: We describe our experience with hybrid PV implantation in an acute pig model. We demonstrated the feasibility of the procedure regarding the surgical technique and perioperative management, and prepared the field for a chronic trial.