European Heart Journal Advance Access originally published online on May 4, 2005
European Heart Journal 2005 26(19):2013-2017; doi:10.1093/eurheartj/ehi307
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New insights in minimally invasive valve replacement: description of a cooperative approach for the off-pump replacement of mitral valves
1Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris cedex, France
2EMIU 0016, Pr Lafon, Faculté de Necker, Paris, France
3Service de Chirurgie Cardiaque, Hôpital Necker Enfants Malades, Paris, France
4IMM Recherche, Institut Mutualiste Montsouris, Paris, France
5Cardiothoracic Unit, Great Ormond Street Hospital, London, UK
Received 15 January 2005; revised 19 March 2005; accepted 31 March 2005; online publish-ahead-of-print 4 May 2005.
* Corresponding author. Tel: +33 1 44 49 45 89; fax: +33 1 44 49 57 24.E-mail address: younes.boudjemline{at}nck.ap-hop-paris.fr
Aims The aim of the present study was to evaluate whether off-pump mini-invasive mitral valve replacement is possible after prior bioprosthetic mitral valve replacement in animals.
Methods and results To validate this concept for off-pump redo mitral valve insertion, we first replaced surgically mitral valves of six sheep under extracorporeal circulation using a Mosaïc® valve. Prior to its insertion, we added a radio-opaque ring on its base to enhance its visualization under fluoroscopy. A bovine jugular valve mounted into a stent was then inserted off-pump through an opening of the atrial wall. Mitral valves were replaced successfully in all animals. Following the surgical valve insertion, mean left atrium and left ventricular end-diastolic pressures were 38 (22–42) and 18.8 mmHg (13–22), respectively. Angiography showed perfectly functioning valves, no subaortic valve obstruction, and a mild paravalvular leak in one animal. In one animal, we were unable to control the bleeding from the atrial opening. In this case, trans-atrial valvulation was not attempted. The off-pump valvular implantation was successful in the other five sheep. Haemodynamic data did not change after the insertion of valved stents. Implanted valves were all competent. The animal with the better haemodynamics was kept alive and is still alive 3 months after implantation.
Conclusion Surgically implanted bioprosthetic valves provide excellent support for off-pump insertion of a valved stent. Further experiments are necessary, in particular with appropriate valve size, before considering this approach for percutaneous mitral valvular replacement in patients with a dysfunctional bioprosthesis.
Key Words: Mitral valve implantation • Valved stents • Prosthesis • Valves • Hybrid approach
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