European Heart Journal Advance Access originally published online on June 20, 2008
European Heart Journal 2008 29(19):2382-2387; doi:10.1093/eurheartj/ehn285
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Minimally invasive off-pump valve-in-a-valve implantation: the atrial transcatheter approach for re-operative mitral valve replacement
1 Department of Cardiac Surgery, Heartcenter, University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
2 Department of Cardiology, Heartcenter, University of Leipzig, Leipzig, Germany
Received 16 November 2007; revised 22 May 2008; accepted 5 June 2008; online publish-ahead-of-print 20 June 2008.
* Corresponding author. Tel: +49 341 865 1424. Fax: +49 341 865 1452. Email: walt{at}medizin.uni-leipzig.de
Aims: This study was designed to evaluate the feasibility and haemodynamic performance of transcatheter valve-in-a-valve (VinV) implantation for failed mitral xenografts using a minimally invasive, transatrial, off-pump approach.
Methods and results: Nine adult sheep (71.1 ± 3.4 kg) underwent mitral valve replacement with a 25 mm bioprosthesis using standard conventional techniques. After weaning from cardiopulmonary bypass, a transcatheter 23 mm pericardial prosthesis mounted on a balloon-inflatable steel stent was deployed within the conventional xenograft. The VinV implantation (10.1 ± 0.9 min) was performed off-pump using an antegrade transatrial approach under fluoroscopic guidance successfully in all nine sheep. Mean transvalvular gradient was 4.6 ± 1.0 mmHg, and five of nine sheep had no paravalvular leak with two sheep each having mild and moderate one. All transcatheter prostheses were confirmed in good position on post-mortem analysis. In an in vitro model, the minimum force required to dislodge the valve was 22.5 ± 3.0 N, which was well above the normal estimated forces generated by the left ventricle (LV). When this model was attached to a LV assist device, the VinV withstood pressure loops of 300 mmHg, without dislocation or embolization.
Conclusion: Transatrial, transcatheter mitral VinV implantation is feasible off pump. This is a truly minimally invasive concept to treat patients with failed xenografts using a right lateral minithoracotomy.
Key Words: Mitral valve • Cardiopulmonary bypass • Valves • Surgery • Catheters • Minimally invasive
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  J. Kempfert, J. Blumenstein, M. W.A. Chu, P. Pritzwald-Stegmann, T. Kobilke, V. Falk, F. W. Mohr, and T. Walther Minimally invasive off-pump valve-in-a-ring implantation: the atrial transcatheter approach for re-operative mitral valve replacement after failed repair Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 965 - 969. [Abstract] [Full Text] [PDF]
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 T. Walther, J. Kempfert, M. A. Borger, and M. Dehdashtian Reply Ann. Thorac. Surg., January 1, 2009; 87(1): 347 - 348. [Full Text] [PDF]
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